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Costa Rica - Health Sector Reform Project (Inglês)

The Health Sector Reform Project for Costa Rica had a highly satisfactory outcome with highly likely sustainability, high institutional development impact, and highly satisfactory performances by both the Bank and the Borrower. The project's achievements included both health outcomes and institutional changes. In terms of health outcomes the project has made contributions in four areas: extending the primary care model to nearly 100 percent of the population; reducing the demand for hospitalization in areas of avoidable morbidity; reduction of infant mortality; reduction of hospital infections through improved monitoring and evaluation under the management agreements and the development of quality assurance mechanisms. With regard to institutional changes, the project demonstrates progress in terms of the introduction of the PHC model, the separation of functions, changes in financial resource management, and the introduction of performance based payment systems. The lessons learned are divided into overall comments on project design and implementation; issues related to the separation of functions, resource allocation and reimbursement mechanisms; and the redefined primary health care model.


  • Data do documento


  • TIpo de documento

    Conclusão da Implementação e Relatórios sobre Resultados

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  • País

    Costa Rica,

  • Região

    América Latina e Caribe,

  • Data de divulgação


  • Nome do documento

    Costa Rica - Health Sector Reform Project

  • Palavras-chave

    Administrative and Civil Service Reform;adequate monitoring and evaluation system;Rational Use of Medicines;average length of stay;separation of functions;delivery of health services;project design and implementation;comprehensive health service;provision of health service;quality health care service;primary health care services;provision of health care;quality at entry;primary care;primary care services;reform process;quality control laboratory;financial resource management;Health and Disability;quality assurance mechanism;social security contribution;principal performance ratings;provision of service;institutional development impact;health reform processes;real growth rate;total public spending;social sector strategy;hospital information system;Health status indicators;net present value;financial management capacity;integrated information system;improvements in efficiency;per capita expenditure;support from community;implementation of reform;integrated health care;drugs and supplies;health insurance expenditure;reallocation of fund;cost of care;acute respiratory infection;delivery of service;level of compliance;quality and efficiency;quality assurance system;resource allocation system;success and failure;allocation of resource;social security agency;gross domestic product;ratings of bank;quality of delivery;human resource development;health care cost;human resource planning;access to training;provision of care;design of reforms;Health Service Delivery;health care financing;outputs by components;social sector policy;efficiency and quality;outstanding government debt;alternative delivery system;informal sector worker;economically active population;labor market condition;preventive health services;management agreement;payment system;health area;decentralization process;project costing;pilot testing;Infant Mortality;payment mechanism;private provider;resource mobilization;clinical management;political will;operational reform;medical supply;hospital infection;borrower performance;outstanding debt;improve revenue;institutional change;metropolitan area;health outcome;private provision;community participation;alternative financing;manpower planning;hospital level;administrative cost;organizational change;health finance;administrative staff;budgetary allocation;organizational structure;project effectiveness;variable cost;financial rate;postgraduate program;institutional impact;loan obligation;budget system;masters program;financial function;external client;financial cost;billing system;financial sustainability;change management;field survey;parasitic infection;cost-benefit analysis;inventory management;risk adjustment;integrated management;community needs;administration support;surveillance system;Hospital Administration;middle management;hospital sector;referral system;health teams;capitation payment;annual budget;learning experience;hospital study;political decision;financing system;hospital reform;laboratory facility;financial incentive;transfer resource;medical materials;hospital performance;existing norm;informal employment;managerial capacity;primary level;tertiary level;promotional activity;Community Services;Proposed Investment;national committee;mandatory contribution;project negotiation;consensus building;average debt;formal insurance;regional hospital;resource transfer;public health;care paradigm;processing time;financial effect;target health;political aspect;employment condition;incentive payment;staff salary;incentive system;socio-economic context;organizational arrangement;external financing;direct communication;ongoing support;counterpart funding;epidemiological surveillance;stated objective;hemorrhagic disease;Infectious Disease;efficiency gain;poverty alleviation;Macroeconomic Stability;world market;financial system;secondary care;introducing competition;diagnostic services;social program;clinic directors;project indicator;payroll contribution;net debt;outpatient visits;life expectancy;political commitment



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