The Business Year

Dr. Marí­a del Rocí­o Sáenz Madrigal

COSTA RICA - Health & Education

More People, More Access

Exec. Pres., Costa Rican Social Security Fund


Dr. Marí­a del Rocí­o Sáenz Madrigal is a Costa Rican medical doctor and public health specialist. She is a former Minister of Health and Coordinator of the Social Council. She is currently the Executive President of the Costa Rican Social Security Fund (CCSS).

"Patients in this day and age are technologically savvy and require easy access to information."

Since being established in 1941, the CCSS has worked to reduce child mortality and increase life expectancy. How has the organization evolved in the way that it carries out its mission?

CCSS is a unique institution in Costa Rica because it was established not only by law but also by the constitution. This is important because in the beginning the main focus was on extending social protection such as healthcare access to more people, especially workers in the formal sector. In these 75 years, we have increasingly covered more kinds of workers, including informal workers and independent workers. The primary source of funding comes from the workers, the employers, and the state, which is markedly different from other systems where funding comes from tax payments or out of pocket ; our social security system is an adaptation of the Bismarck model. The CCSS was originally a healthcare system for people affected by disease; however, we now integrate services such as health promotion and prevention, immunizations, and a holistic approach to healthcare, from primary healthcare through tertiary care. It provides comprehensive care: Costa Ricans can receive immunizations to prevent diseases as well as top of the line cancer treatment, cardiac disease management and organ transplants. Our package is implicit, not explicit, meaning that we are charged with serving all those in need of healthcare services. We make no distinction between the individuals of different income groups; everyone living in Costa Rica has the same opportunity to benefit from quality comprehensive healthcare services. This kind of universal healthcare coverage make Costa Rica stand out as quite different from other countries, and we are proud of this. This approach reduces child and maternal mortality rates, and our life expectancy is around 81 years, with much of the population living well beyond 80 years. As with other countries with a growing elderly population, we are in the midst of an epidemiologic transition, where the population still suffers from acute infectious diseases but is also being afflicted by chronic diseases such as cancer, diabetes, and cardiovascular ailments. The management of these diseases is more expensive, so one of the challenges that we are currently addressing is the strengthening of a system that would follow individuals throughout their life cycle—through health promotion, disease prevention, opportune care, and management of disease, rehabilitation, and palliative care in end-of-life conditions.

What are some of your current projects and initiatives?

Patients in this day and age are technologically savvy and require easy access to information about their own health processes and health in general. Applying cutting-edge technological advances to health also allows us to optimize resources, provide the healthcare teams with opportunities to collaborate with their peers in distant locations, and to share patient information that will result in more efficient care and better health outcomes. The medical records are being digitalized in their entirety, beginning at primary care and continuing through the highly specialized hospitals in the nation’s capital. This effort requires a technological platform that will support this initiative in every healthcare establishment in the country, so clinics, hospitals, and administrative offices are being fully equipped for this purpose. Of 1040 national Basic Teams for Integral Health Care (EBAIS), 94% have implemented the agenda module, 83% have loaded the family records module, and 81% have uploaded all heath charts into the EDUS system. 73% of the hospitals are utilizing the surgical module in their surgical departments. Another key initiative is the project entitled “Fortification of Health Care Services” to improve the health of the population in the entire healthcare system by strengthening primary care. After careful analysis of key indicators, a region of the country was selected to become the originator of innovations that are centered in the patient, and improve the experience and outcomes in every scenario, from home, school, and community, through primary care and regional, national, and specialized hospitals. Multidisciplinary teams conformed by healthcare professionals from each of these scenarios are the ones responsible for crafting and implementing this paradigm shift in the way healthcare is designed and provided in this country.

What strategy is CCSS following to solve the issue of patient waiting lists?

Like other systems that offer universal healthcare, waiting lists are a challenge that we are addressing with creative, patient-centered initiatives, designed and driven from the hospitals themselves. We are working with different kinds of strategies to increase the optimization of our capacity and resources, including alternative schedules, specialized ambulatory surgery campaigns, and optimization of surgical suite utilization among others. Influenza vaccine administration is another example of opportune patient-centered care. Costa Rica’s comprehensive immunization schedule includes 15 different vaccines for children and adults. Special at-risk populations like children younger than two years of age, the elderly, and those suffering with other pre-existing conditions like asthma or diabetes, were prioritized when the vaccines were administered.

How do you assess the Costa Rican healthcare sector overall?

Our healthcare system is strong, both in the private and the public sectors. Most private-sector players are providing specific services, such as consultation. Most high-end interventions are only offered by the public sector. The principal message I would like to convey is that operating a social security system in Costa Rica takes time and commitment on the part of politicians, the private and public sectors, the workforce, and the general population. We need to move toward a consensus as a society, not just to build and strengthen the system, but also to build the sustainability of said system. The CCSS is an integral and essential part of this effort to provide healthcare services that produce the best health outcomes for all inhabitants of this country, with special emphasis on vulnerable populations.

What are your priorities for 2017?

The priorities for 2017 have been established in the institution’s strategic plan 2015-2018, which has been developed across three strategic axes: healthcare services, institutional management, and financing. Each axis has strategic themes that include health, pensions, infrastructure, information technology and communication, evaluation and accountability, human resource management, and financing, among others. Priorities for 2017 include implementation and evaluation of the project for the Integral Development of Strategic Functions of Human Resources, Project for the Organizational Restructure of Central Administration, and the Fortification of Health Care Services project. Infrastructure projects include remodeling emergency services and building new hospitals where population changes have exceeded current capacity. Innovative technology will also be a pivotal component of prioritization in 2017, not only for health services but also for education, including telemedicine and apps for patient use. The CCSS is being positioned to evolve significantly over the next several years.



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