Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Strengthening Universal Health Insurance in Costa Rica (P148435) LATIN AMERICA AND CARIBBEAN | Costa Rica | Health, Nutrition & Population Global Practice | IBRD/IDA | Program-for-Results | FY 2016 | Seq No: 4 | ARCHIVED on 27-Dec-2017 | ISR30743 | Implementing Agencies: Caja Costarricense del Seguro Social, Ministry of Finance Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) The objectives of the Program are to contribute to: (i) improving the timeliness and quality of health services; and (ii) enhancing the institutional efficiency of the CCSS. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  Satisfactory  Satisfactory Overall Implementation Progress (IP)  Satisfactory  Satisfactory Overall Risk Rating  Moderate  Moderate Implementation Status and Key Decisions The Strengthening Universal Health Insurance in Costa Rica Program-for-Results was approved by the Board of Directors on March 15, 2016. A loan in the amount of US$420 million was signed by the Government of Costa Rica and World Bank on April 21, 2016 and the loan was declared effective on November 17, 2016. As of May 2017 the loan has disbursed US$ 105 million. The Program is progressing well towards achieving its Development Objectives. Data on Financial Performance Disbursements (by loan) 12/27/2017 Public Disclosure Copy Page 1 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed P148435 IBRD-85930 Effective USD 420.00 420.00 0.00 105.00 315.00 25% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P148435 IBRD-85930 Effective 15-Mar-2016 21-Apr-2016 17-Nov-2016 30-Apr-2022 -- Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Substantial  Substantial  Substantial Macroeconomic  Substantial  Substantial  Substantial Sector Strategies and Policies  Moderate  Moderate  Moderate Technical Design of Project or Program  Moderate  Moderate  Moderate Institutional Capacity for Implementation and Sustainability  Moderate  Moderate  Moderate Fiduciary  Moderate  Moderate  Moderate Environment and Social  Low  Low  Substantial Stakeholders  Moderate  Moderate  Moderate Other  --  --  -- Overall  Moderate  Moderate  Moderate Disbursement Linked Indicators (DLI) PHDLIPDOTBL  Percentage of major surgeries from priority list conducted in outpatient settings according to CCSS institutional guidelines. (Percentage) Baseline Actual (Previous) Actual (Current) Value 18.00 -- -- Date 29-Feb-2016 -- -- PHDLIPDOTBL  Cumulative percentage of target population personally invited to undergo colon cancer screening in five priority counties. (Percentage) Baseline Actual (Previous) Actual (Current) 12/27/2017 Public Disclosure Copy Page 2 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Value 0.00 -- -- Date 29-Feb-2016 -- -- PHDLIPDOTBL  Percentage of individuals diagnosed with Diabetes Type II that are under optimal clinical control. (Percentage) Baseline Actual (Previous) Actual (Current) Value 39.00 -- -- Date 31-Dec-2014 -- -- PHDLIPDOTBL  Pilot project on integrated health networks approved by the CCSS Board and implemented for a selected population and territory and evaluated with the results publicly disseminated. (Text) Baseline Actual (Previous) Actual (Current) Value - -- -- Date 29-Feb-2016 -- -- PHDLIPDOTBL  Percentage of total number of primary health care units (Areas de Salud) with the Unique Digital Health Record e-health package (EDUS). (Amount(USD)) Baseline Actual (Previous) Actual (Current) Value 50.00 -- -- Date 29-Feb-2016 -- -- PHDLIPDOTBL  Redesign, implementation and use of data collected by the new annual survey to measure impact of new interventions to improve patient satisfaction. (Text) Baseline Actual (Previous) Actual (Current) Value - -- -- Date 29-Feb-2016 -- -- 12/27/2017 Public Disclosure Copy Page 3 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) PHDLIPDOTBL  Development and execution of a comprehensive medium- and long-term plan to ensure the financial sustainability of the CCSS. (Text) Baseline Actual (Previous) Actual (Current) Value - -- -- Date 29-Feb-2016 -- -- Results Results Area Intermediate Results Area Project Development Objective Indicators PHINDPDOTBL  Percentage of major surgeries from priority list conducted in outpatient settings according to CCSS institutional guidelines (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.00 -- -- 40.00 Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDPDOTBL  Cumulative percentage of target population personally invited to undergo colon cancer screening in five priority counties. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 40.00 Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDPDOTBL  Percentage of total number of primary health care units (Areas de Salud) with the Unique Digital Health Record e-health package (EDUS) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- -- 80.00 12/27/2017 Public Disclosure Copy Page 4 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDPDOTBL  Development and execution of a comprehensive medium-and long-term plan to ensure the financial sustainability of the CCSS (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Annual budget Budget does not use execution using Value -- -- prospective tools. prospective tools. Date 29-Feb-2016 -- -- 29-Apr-2022 Overall Comments Intermediate Results Indicators PHINDIRITBL  Cumulative percentage reduction in average waiting days for selected procedures (tracers): hip and knee replacement. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1032 days -- -- 35% lower Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDIRITBL  Percentage of individuals diagnosed with hypertension that are under optimal clinical control. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 62.00 -- -- 64.00 Date 31-Dec-2013 -- -- 29-Apr-2022 PHINDIRITBL  Percentage of households covered by the Family Socio-Economic & Health Risks Information File. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target 12/27/2017 Public Disclosure Copy Page 5 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) Value 70.00 -- -- 100.00 Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDIRITBL  Percentage of households with Family Socio-Economic & Health Risks Information File digital geo-referencing data available online. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 16.00 Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDIRITBL Use of institutional strategic intelligence system data to publish and disseminate two annual reports measuring progress of SASHI (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target System designed, approved and launched Value - -- -- Two annual reports published and disseminated Date 29-Feb-2016 -- -- 28-Apr-2022 PHINDIRITBL  Institutional Review of core institutional management functions, and operational plan for progressive implementation of streamlining central level management. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Approved by Board of Value - -- -- Directors Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDIRITBL  Financial statements produced using new international public accounting standards, streamlined and digital automated processes. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Approved Value - -- -- Evaluation report of first 12/27/2017 Public Disclosure Copy Page 6 of 7 Public Disclosure Copy The World Bank Implementation Status & Results Report Strengthening Universal Health Insurance in Costa Rica (P148435) two years Annual Financial Statement using outputs from new automated streamlined system Date 29-Feb-2016 -- -- 29-Apr-2022 PHINDIRITBL  Shadow budget constructed based on gender and age risk adjusted capitations. (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value ND -- -- Completed Date 29-Feb-2016 -- -- 29-Apr-2022 Overall Comments 12/27/2017 Public Disclosure Copy Page 7 of 7