Resumo

MUISER, Jorine. The Institutionalization of Universal Health Policy in Costa Rica and Current Challenges. Rev. costarric. salud pública [online]. 2013, vol.22, n.2, pp.94-103. ISSN 1409-1429.

Objective: To analyze the role of the Ministry of Health in Costa Rican public policy. Methods: The analysis is a case study comparing two periods (1950 - 1990 and 1990 - 2010) using qualitative data collection instruments, including review of literature and institutional documents as well as in-depth interviews and focus group discussions, all with data triangulation. Results: The analysis found important differences between two periods: before the 1990s,consecutive governments were strongly committed to the pursuit of universal health coverage (UHC); afterwards, resources moved to the Caja Costarricense de Seguro Social (CCSS) and the private sector, causing a chain of effects that complicated the search for financial sustainability. Discussion: The 1990s health system reforms were a turning point in Costa Rica’s UHC process. Searching for increased efficiency and sustainability, primary health care was integrated into the CCSS schemes triggering an implicit boom in private sector activity, also related to changes in the political-economic context. The plan to strengthen the Health Ministry’s stewardship role did not really succeed. UHC in Costa Rica enjoys strong popular support, which guarantees a level of political sustainability, but to ensure its financial sustainability, concerted government action is required to improve interinstitutional, sectorial and inter-sectorial coordination.

Palavras-chave : Política de Salud; Seguro de Salud; Política Social.

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