The central government is responding to a critical evaluation of the Caja Costarricense de Seguro Social by setting up another committee and setting up a team of experts to make changes in the agency.
The Caja runs the nation’s public heath system, including hospitals and clinics.
A special commission of four persons made public some 81 recommendations Monday. If they can be reduced to just one imperative it is to run the Caja like a business. The suggestion is to get professionals to run the sprawling network both at its center and at the many hospitals. The report did not say so exactly but it implied that professional administrators be hired to run the hospitals. Now the bulk of hospital directors are physicians who came up through the ranks.
The report on the Caja was the topic when the president’s cabinet met Tuesday. A summary of the meeting said that a team made up of persons from four ministries would be formed along with Caja representatives to evaluate the recommendations and see to their execution.
The cabinet, the Consejo de Gobierno, set Oct. 12 as the day when a timetable is presented along with an outline of actions to take and resources needed. If new legislation is needed, the executive branch will present it when it controls the agenda of the Asamblea Legislativa, it said.
The cabinet also is seeking a monthly report from the executive president of the Caja about advances in the process. In addition, the cabinet wants a detailed report on the first Tuesday of each month of the team of experts set up to make changes and also a report from the executive president so that the cabinet can monitor the progress.
The 58-page report on the Caja said that as of June 2010 1,075,528 salaried workers were enrolled as subscribers. There
were 138,767 independent workers enrolled and 120,645 who chose to enroll voluntarily. There were 77,588 persons enrolled through various separate agreements and 24,401 who were enrolled but their relationship was unknown.
The report points out that problems with the Caja started to become obvious in 2009 when payments to service and material providers slowed down. In March, the Caja board of directors sought help from the Panamerican Health Organization, which presented a summary of what was called the true situation of the institution in July.
That same month the board of directors asked the two economists, a sociologist and a businessman to form a commission to analyze the Panamerican Health Organization report and to make recommendations in the short-, medium- and long-term. That was the report delivered Monday.
The basic finding of the Panamerican Health Organization was that in the last few years the expenses of the Caja increased much more rapidly than income. The Caja was estimated to post a 118 billion colons deficit in 2012 if no action was taken, according to the report. That is about $230 million.
Part of the income problem was blamed on lower social security payments by employers due to the economic slowdown. The central government also has been slow to pay its share and there were problems in collection, said the report Monday.
According to the report, employers were expected to pay 1.1 trillion colons or about $2.2 billion in social security charges. This amount includes money deducted from employee salaries.
The report by the four individuals did not recommend increasing the percentage of salary that employers had to remit to the Caja. But it is possible that the central government will take steps to do that.
The Caja has become more important to expats living in Costa Rica since immigration rules forced them to affiliate to preserve their residency status.