QCOSTARICA — The possibility of promoting new public-private alliances in the health sector is once again a topic of discussion at a critical time for the Caja Costarricense del Seguro Social (CCSS)
The threat of resignation of 2,000 medical specialists in the coming days if their salary demands are not met puts the institution between a rock and a hard place, and generates concern in various sectors for the health of patients.
The mass resignation would not only further complicate the long waiting lists for appointments and surgeries, which already exceed a year on average in both cases, but would also intensify the suffering of patients, whose conditions could be aggravated by the lack of timely care.
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“Costa Rica must move towards the privatization of health. You do not hear of problems with doctors or strikes in the Ebais and clinics outsourced by the CCSS. “We have to extend this to the entire country, to clinics and all Ebáis,” said Otto Guevara, former legislator and private consultant.
Another fundamental aspect is the reform to the law to remove from the College of Physicians of Costa Rica the power to determine whether or not a foreign professional can provide consultation in Costa Rica. In this case, it should be the Ministry of Health, as happens in other countries, and not depend on a union that defends the economic interests of its members.
Last April, the CCSS identified ten critical specialties in terms of human resources, including anesthesiology, cardiology, surgery, dermatology and endocrinology. However, the problem of human talent affects 38 specialties, according to the latest reports.
To resolve this situation, it is key to open more training possibilities in universities and private clinics, instead of depending exclusively on a small number of educational centers and public hospitals.
This affects the supply of human talent and allows specialist doctors to have the ability to bring social security to its knees.
“A national policy must be established that defines the country’s needs in terms of new human resources, especially specialists. It is necessary to think of innovative ideas in the training of specialists, such as greater regionalization in training and the use of private universities and hospitals,” said Massimo Manzi, Executive Director of the Costa Rican Chamber of Health.
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The shortage of specialist doctors and the possible mass resignations has already been declared a national emergency by the Ministry of Health.
The conflict originated from a decision by the CCSS Board of Directors on July 4, which established a global monthly salary of ¢2.8 million colones for doctors hired after March 10, 2023.
This measure left out 2,096 doctors hired before that date, whose composite salaries are, in many cases, less than ¢2 million colones.
Doctors are demanding better salary conditions and have warned that if they do not receive them, they will proceed with mass resignations starting this week.
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What will the CCSS do to contain the emergency? In order to mitigate the impact of the mass resignation of specialist doctors, the CCSS will implement several actions, among them:
- Teleguidance: This will allow patients to communicate with general practitioners or professional nurses. Questions about medications, treatments, missed appointments and other concerns will be addressed in this way
- Telediagnosis: Radiologists will issue reports of diagnostic studies, such as tomography, remotely and in real-time.
- Teleinterconsultation: General practitioners will be connected with specialists, who will provide support in decision-making.
- New staff: Incorporation of recently graduated specialists, who will be able to work in the institution before starting their mandatory social service, and the hiring of retired doctors.
Additionally, options are being explored for hiring with the private sector to fill vacancies in critical specialties
Difficult situation. The lack of specialists, the public employment law and political ineffectiveness have put the CCSS between a rock and a hard place. Mostly through its own doing, such as struggling to adapt to changing realities.
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