Contracting primary health care services - The case of Costa Rica

This chapter outlines the Costa Rican experience with the introduction of a contracting model and highlights some of the key results evaluating the performance of the model in comparison to the traditional public model. Using both performance evaluation data from the Caja Costarricense de Seguro Social (CCSS) contracts and a panel data set on clinic-level outputs, the chapter analyzes the development of the primary health care (PHC) contracting model in Costa Rica and compared the performance of health cooperatives in Costa Rica with traditional, publicly managed clinics in the social security system. Under both methods, the contracted providers consistently provide better performance than traditional CCSS public clinics. Even controlling for catchment area characteristics, time trends, complexity of clinic, and existence of performance contracts, contracted providers conducted significantly more general practitioner visits per capita and significantly fewer specialist visits per capita than traditional clinics. At the same time, the per capita rate of emergency visits and first-time patients seen did not differ from that in the traditional clinics. These measures combined resulted in 30 percent lower expenditures per capita in contracted providers than in the traditional clinics. The findings presented suggest that the contracting model in C osta Rica is promising. As this chapter shows. cooperation between the sectors has worked well there, where contracted providers have been in operation long enough to produce reliable results. Clear evidence is shown that the public-private partnership model offers important opportunities to increase provider performance within a sustainable framework.