The ailing Caja Costarricense de Seguro Social needs a new board of directors and should clamp a lid on hiring, according to a committee set up to study the nation’s medical service provider.
The committee also said Monday in its report that the Caja can be salvaged without raising the amount of money employers and employees have to pay as social charges each month. However, it also suggested that the legal foreign residents in Costa Rica as rentistas be assessed a monthly amount based on a monthly income of $2,500.
The Caja runs the nation’s public hospitals and the many local clinics. However, it is facing hard financial times, in part because government agencies have not paid all the money they owe. The Caja also appears to be losing money on questionable disability claims by its employees and improper handling of its supplies. Many supplies and medicines end up being incinerated because they have expired or suffered problems from heat or water damage.
The Caja also was the victim of a $32 million purchase of unneeded medical equipment. That case resulted in the conviction of former president Rafael Ángel Calderón Fournier. But neither Calderón nor others convicted with him went to jail because the Sala III high criminal court reduced their sentences.
The commission report Monday includes the suggestion of replacing the entire board of directors of the Caja with persons skilled in business and the law. The report also said that a sharper eye should be kept on salary expenses and that collection of money owed by employers should be stepped up.
The four-person commission provided a list of 81 recommendations. Among them is a suggestion that the central government and the Caja come to terms on payment of the outstanding debt and arrange a payment plan.
The report also said that hiring should be frozen as of Oct. 1 for a period that continues through 2012. After that employment should increase no more than 1 percent, it said. The report also said that all purchases should be publicized through the Gobierno Digital system on the internet.
The commission also suggested migrating the Caja’s computer systems to free software over the next two years and to create positions of general manager at each hospital using people who were not physicians. It also urged speeding up the use of electronic appointments for patients using the Caja system.
Most foreign residents who are here legally are required to affiliate with the Caja now whether or not they use its medical services.
The recommendation about rentista residents appears to be directed at those who declare income lower than that required to maintain that immigration status or those who participate in group plans where their payment is not based on their monthly income. Rentistas now have to show an income of at least $2,000 a month in order to earn residency through the Direccion General de Migración y Extranjería.
The bulk of the expats who sign up with the Caja do so as an asegurado voluntario because they are not otherwise employed here. The signup process is supposed to include questions about monthly income, so many foreigners already are probably paying an amount based on an income of from $2,000 to $2,500. The rate appears to be around 10 percent.
The commission also may have included pensionados when it used the term rentista. Pensionado income is at least $2,000 a month for those who recently acquired the status. Long-time pensionados and rentistas are held to lower monthly incomes.
The commission members were economists Fernando Naranjo Villalobos and Pablo Sauma Fiatt, businessman Rafael Carillo Lara and sociologist Juliana Martínez Franzoni.
The thrust of the report seemed very much like an assessment of a business in financial trouble with many of the same recommendations, including trimming the central office workforce.