Thursday 30 November 2023

Co-pay key to reduce CCSS waiting lists

With the promise of less waiting for more services, today, the CCSS presented the strategy to reduce waiting lists.

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30 November 2023 - At The Banks - Source: BCCR

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QCOSTARICA — The Caja Costarricense del Seguro Social (CCSS) and the Government, presented on Tuesday a strategy to solve the problem the country is experiencing with waiting lists for public health services.

Costa Rica president Rodrigo Chaves looks on as the president of the Caja Costarricense de Seguro Social, Martha Esquivel, signs the “Less waiting, better service” campaign

“We are going to buy services, apply shared payment and refine the costs of the Caja to meet the goals, we are going to go against all odds, those who support us are welcome and those who do not, don’t get in our way,” said CCSS executive president, Marta Esquivel.

Among the possible solutions for the insured, is the issue of co-pay, which means that the CCSS and the (insured) patient each provide a percentage of the cost of a medical procedure.

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According to Esquivel and CCSS financial manager, Gabriela Artavia, it is an issue that continues to be analyzed.

Esquivel affirmed that the board of directors had previously decided to examine the issue of co-payment in 2021, and that they had revisited the topic and were currently assessing it.

“What is missing is very little to take it to the meeting, now it is in the hands of financial management and my intention is that by January or February 2024, it will be a possibility for users,” Esquivel said.

Since May, an emergency declaration was issued due to waiting lists that have patients waiting for years for surgery, among other services.

It wasn’t until Tuesday, November 7, that the “Menos espera, mejor servicio” (Less waiting, better service) campaign was announced.

“The institution is complex and decisions take months and years, but if an emergency was declared, it is to move faster in the search for solutions. I expect the financial scheme to be presented to the board in about 15 days,”  Esquivel acknowledged.

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Percentages to be defined

While co-pay is on the list of becoming a reality, CCSS medical manager, Wilburg Díaz, reiterated that for the application of co-pay, financial analysis and determining the percentages are required.

“From a financial point of view, it requires an entire analysis that management is carrying out to determine percentages, feasibility and sustainability,” Díaz confirmed.

That is, there is no defined plan yet as to what percentage users will be required to pay.

Esquivel emphasized that it will be a voluntary alternative, which will be used as a strategy when it is seen that the system is collapsing in some areas.

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“It is not permanent, this is for the institutional emergency and to be able to help us efficiently and effectively to lower the waiting lists,” Esquivel stressed.

Another issue proposed is the contracting of services from third parties, but like co-payment, it has yet to be defined.

“Co-payment and contracting of services, it is not that the Caja is going to go out and buy everything. It has a structure based on what the Unidad Técnica de Listas de Espera (Technical Waiting List Unit) is pointing out that there are studies, procedures, and surgeries that are not highly complex, with a technical guide, they are not occurrences,” Esquivel clarified.

“Currently we have some specific points such as CT, MRIs and other types of procedures that allow us to quickly define the health situation of a patient,” Díaz added.

Rodrigo Chaves giving his sales pitch to the plan

Unions criticize

The Sindicato Nacional de Enfermería y Afines (SINAE-AFINES) – National Union of Nursing and Allied Workers – labels the situation as more promises without actions, as it is a proposal that the board of directors is unaware of.

Lenin Hernández, Secretary General of the SINAE-AFINES, was clear in saying that thousands of people are urgently waiting for a diagnostic, therapeutic, or surgical procedure, which is why waiting lists have become death lists.

“When it comes to a project of this nature, the essential thing is not only the planning, execution but starting from the essential thing such as having the endorsement of the board,” said the union leader.

“With this serious governance problem, Marta Esquivel and her team working with a parallel board, with a team isolated from the necessary coordination in terms of management, those responsible and part of the financing, we believe that they are not going to achieve anything,” Hernandez noted.

The Unión Nacional de Empleados de la Caja y la Seguridad Social (Undeca) – National Union of Cash and Social Security Employees – also joined in criticizing the Government’s announcement.

“Now they are making a co-payment proposal, absolutely unjustified and lacking technical foundation and legitimacy to ‘resolve’ 40,000 low-complexity procedures, and they assure that it is voluntary. This unpleasant modality generates discrimination and inequality,” accused Luis Chavarría, the leader of the union.

Not more than one year

Among the goals presented by the CCSS:

  • People diagnosed with cancer, do not wait more than 45 days for a procedure.
  • For complex surgeries, the patient does not wait more than 120 days.
  • For low-complexity surgeries, the wait is no longer than 365 days.
  • And by the end of 2025, the goal is for no patient to wait more than 1 year for surgery.

To accomplish the above, the plan involves increasing the number of experts, and patients who are not seen in a timely manner at the Caja having the option of selecting another healthcare provider, and allocating ¢200 billion colones to address backlogs and address structural issues.

Tooting her own horn, Esquivel pointed out that in one year of her management the following was achieved: 125 days less waiting for surgery (the waiting time went from 572 days in September 2022 to 447 days in 2023), 112 days less waiting time in orthopedics and 69 days less in ophthalmology.



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