QCOSTARICA – 555 days or a year and two months on average, is what a patient must wait to finally undergo the surgery scheduled in a public hospital. That is the average in public hopsitals, because there are specialties where the wait time is even longer, such as in Orthopedics, where the way time can be more than two years 771 days on average.
Such expectations seem to be another non-pandemic wave, a sequel to covid-19, which will also consume important resources in time and money from the Caja Costarricense de Seguro Social (CCSS) for many months.
Scheduled or elective surgeries are the most affected with intermittent shutdowns of public health services in the last 19 months. Before the pandemic, the average waiting time for surgery was 329 days, a figure well above the maximum time considered ‘reasonable’, of three months or 90 days.
Currently, that average shot up to 555 days, according to figures provided to La Nación by the Technical Unit of Waiting Lists (UTLE), attached to the Medical Management of the CCSS, as at August 31.
After Orthopedics, the most critical surgical specialty is Neurosurgery, with a waiting time of 598 days, followed by Otolaryngology, with 587 days, Peripheral Vascular (547), and Urology (543).
Between 2019 and August 2021, Orthopedics added another 229 days to their already long waiting times, Neurosurgery 200, Otorhinolaryngology 265 days, Vascular 279, and Urology 213 more days.
Other surgical specialties, such as General Surgery, increased their waiting times to operate by 194 days (it went from 328 days in 2019 to 522 in 2021), and Ophthalmology added 226 days of waiting, for a total of 474 days in August last.
The coordinator of the UTLE, Marny Ramos Rivas, acknowledged that this increase in terms will continue as long as the number of surgeries is not increased and, there will hardly be more if only the installed hospital capacity is taken into account in ordinary time.
“We are in the last stage of the recovery and adaptation plan, which gives more potential to the surgical and to special projects. The institution has been carrying out important planning, with the incorporation of 189 new specialists and with the opening of more surgical rooms,” assured Ramos.
The Caja budgeted for next year, an initial fund of ¢20 billion colones allocated to projects aimed at reducing waiting times on non-ordinary hours (after 4 pm). To date, 50 have been approved in different hospitals and health areas, confirmed the coordinator of the UTLE.
The different covid-19 pandemic waves forced hospitals to focus surgical care on emergency cases, cancer patients and highly justified referrals of patients on the waiting list for scheduled surgeries.
The pandemic halted the advance of what was known as the Plan de Atención Oportuna a las Personas (Timely Care Plan for People), which was presented before the Constitutional Court during the process to comply with the sentence of April 2019, which ordered the CCSS to create a system that would reduce waits to reasonable terms.
The reduction in the number of cases, hospitalizations and deaths related to covid-19, in the last five weeks, once again gives hospitals a break to resume surgeries. Hospital centers reached 60% of normal surgical production in September, although there were months like April, with a reduction in the pandemic curve that allowed up to 79%.
“This year, it has been characterized by going up in the surgical part, with the exception of the months with the rise of the wave, which produced a contraction of services. We do believe that it will be much higher than 2020,″ said Ramos.
According to information from the Caja’s Health Statistics Area, 104,940 operations had been carried out as of September, 80% of all last year. Ramos expects that in the next three months this number will increase and exceed that in all of 2020, when 131,598 surgeries were performed.
Of the operations that took place between the first and second pandemic years, 42% are cases that come from waiting lists.
Appointments and exams
The average waiting times for diagnostic procedures and the first appointment with the specialist, decreased slightly. The average waiting period for exams went from 145 days in 2019, to 137, according to the cutoff to August 31.
The wait for an appointment is currently an average of 305 days (312, in 2019). However, they are still well above the 90-days.
In diagnostic procedures such as ultrasounds, the wait is 236 days. They’ve only gone down four days since 2019. The wait for a gastroscopy is 188 days, and for an EKG, 157 days.
Mammograms and CT scans do remain below the 90-day waiting period, with 65 and 80 days, respectively.
For its part, the longest times for the first appointment with the specialist doctor are recorded in Ophthalmology (479 days), Orthopedics (395) and Urology (369).
According to the UTLE, both appointments and procedures have been recovered to 100% of their capacity. Above all, consultations with specialists, which are still worked in a mixed modality: face-to-face, virtual or by phone call