(qCOSTARICA BLOGS) The CAJA, or Caja Costarricense de Seguro Social, as it is more correctly and formally referred to, is probably the most powerful Government institution in Costa Rica, along with the Tax Department (Ministerio de Hacienda and Tributacion).
Essentially, these two institutions have the power to “declare you guilty until you prove yourself innocent”, the reverse of most Democratic institutions and the notion of the Rule of Law. Wielding such power, why is the CAJA always being operated at a deficit? They have been known to have forced many small businesses to close and lay-off workers, based on trumped-up claims against the business owner for specious back payments for employee pay-roll deductions, which the owner is forced to defend against, or pay, with excessive interest and penalty charges added on.
The CAJA, of course, is charged with among other things, such as payment of worker and disability pensions, administering the Government socialized Medical System.
Being from Canada, I’m very familiar with the universal socialized Government Medical System in place there. The Canadian Medical System is likewise in financial difficulty, providing a much poorer quality of service today, than it did many years ago when I lived there. Many Canadians, who have the economic means, are now forced to go to the U.S., or other jurisdictions, to pay for life-saving medical services that they would wait months to receive in Canada.
This is, of course, exactly what is happening in Costa Rica as well with the CAJA Medical System, forcing those that can afford doctors in private practice and private medical clinics to pursue that option. The recently publicly exposed back-log of patients for relatively routine, but life-saving medical procedures, by a CAJA doctor working in the Cardiology Department of Hospital Mexico, is a good example of such.
What both the CAJA and the Canadian socialized medical systems have in common, is that there is no deductible, or user fee amount which must be paid by users for the receipt of medical services.
Accordingly, there is a considerably high level of abuse by users in both Systems. The elderly abuse the Systems by utilizing valuable doctor-time to combat loneliness, when such could be more efficiently and economically handled by Government Social Workers. In Costa Rica, where even prescription meds are included in the insured amount, vast quantities of non-required prescriptions are filled on a daily basis.
In my opinion, these abuses could be effectively cured by having a small user fee/deductible amount charged to all medical system users at the time of utilizing any such insured service provided. The amount of the deductible portion would not have to be large, as the requirement of “digging-into-your-pocket” to pay any amount, would make users think twice about their true requirement to avail themselves of any particular medical service that they are seeking.
If this practice of charging a user fee were implemented, I believe that the current level of abuse of medical services could be greatly curtailed, with no denial of access for such medical services for legitimate users, and with the benefit of moving toward “balancing the books” at the CAJA.