International experts place Costa Rica as a leader
in health in Latin America, say Social Security

By the A.M. Costa Rica staff

Social Security reports that international experts place Costa Rica as one of the leading countries in health and pensions in the Latin American region.

Doctors Reginald Thomas, director of the Inter-American Center for Social Security Studies and Renato González Carrillo, of the Inter-American Conference on Social Security, who are in the country participating in a seminar provided the information.

The seminar called: "Mortality tables: construction and use in social security", which takes place during this week at the Center for Strategic Development in Health and Social Security and in which there are other representatives participating. They include people from Panama, Honduras, Paraguay, and Mexico.

The specialist said that the challenges in the region are important and that Costa Rica does not escape from them, but that the Costa Rican Social Security and Pension System has taken steps on issues where few countries have achieved it.

Thomas and Gonzalez said that one of the most important points of the country’s services is the universalization of services and the possibility that anyone can receive medical care anywhere in the country, in addition to a solid pension system for the elderly.

"For example, with the issue of migration, there is no better place to be a migrant than Costa Rica," said Dr. González. "In the case of Mexico, the country does not have hospitality like the Costa Ricans has, despite the fact that the migratory flows to North American countries are large."

For his part, Dr. Thomas said that the challenges of the health and pension system in Costa Rica are similar to those of the rest of the world since there are issues that go beyond social security.

"The economic reality of the countries is crucial for their social security systems and critical factors depend on that: market trends taxpayers rate, investments rate, among others," said Dr. Thomas.

According to Dr. Thomas, the actual demographic and epidemiological conditions are emerging for the next generations, and Social Security must respond to these changes in the country.

The specialist said that people who have informal work, that is people who work and are not affiliated with Social Security, are one of the country's challenges that has the greatest effect on Social Security.

Specialists think that in Costa Rica the percentage of working people who are not affiliated with Social Security is not as high as in other countries. For example in Mexico, Brazil, Argentina this figure exceeds 50 percent.

According to the specialists, another challenge for Latin America is migration, since the people of the region are constantly moving.

With regard to the medical service provided by Social Security to its members, in April, as A.M. Costa reported, the court has given this public institution 6 months, until October, to reduce patient waiting lists in hospitals.

On April 1st, the Constitutional Court Chamber ordered Social Security to design, in a maximum of six months, an integrated management system to reduce the "disproportionate and unreasonable deadlines that the patient should expect to receive care in hospitals," said the ruling. The problem is one that represents a systematic and repeated violation of the right to health.

Judges ordered the system in response to an appeal by a senior citizen filed on September 13, 2018.

The citizen said that she required surgery at the San Rafael Hospital*  in the province of Alajuela, but that she was not informed of a specific date for the operation and she was placed on the waiting list. For this reason, the woman appealed to the Constitutional Court alleging that her right to health was violated by the medical center.

The Constitutional Court concluded that the problem in terms of excessive waiting lists is a constant in Social Security. "These actions in the provision of public service violate the right to health, as a fundamental right autonomous and violate the constitutional principles of public service," said the resolution statement.

Social Security must define reasonable waiting times for treatments, as well as objective criteria to specify the location of a patient on waiting lists. It was also required to set a schedule of actions to meet the goals.

Within the plan, Social Security should propose solutions to the shortcomings and problems recognized by the institution itself: lack of adequate infrastructure, lack of specialized doctors, equipment needs, and the absenteeism of patients to appointments in various medical centers, among others.

In order to follow up on compliance with this ruling, the Constitutional Chamber set a public and oral hearing for 9 a.m. on November 14, in the Supreme Court of Justice. On that day, the authorities of Social Security must present the advances and actions developed.

In addition, it was urged that Catalina Crespo- Sancho, in her capacity as Ombudsman, assist in the follow-up of the execution of this resolution.

The ruling includes:

- The order in which Social Security must attend waiting lists.

- Define reasonable waiting periods by pathology or related diagnostic groups according to the symptomatology, the level of urgency and the patient's conditions.

- Determine the objective criteria to set a patient on the waiting lists.

- Set a progress schedule.

- Take into account such special groups as older adults, with people with disabilities, and minors.

- Respect the constitutional principles in public service of efficiency and effectiveness.
 
According to the statistics of the Constitutional Court, in 2018, were registered 7,037 claims against Social Security for violating the right to health.





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