|The Nutrition and Health Transition of Democratic Costa Rica (INFDC, 1995, 228 p.)|
|2. Development of the social security institute|
The development of the first National Health plan represented an unprecedented combination of actions. The face that the Ministry of Health assumed full responsibility for individual and collective health promotion, implied that if it was effective, the demands for outpatient visits and hospital beds in the Social Security Institute would be significantly decreased. The decrease in pediatric beds in the last 15 years is the best evidence of the achievement of the program of primary health care. The pediatric beds are now barely two- thirds of those required in 1974, although the child population has doubled (Table 3). The Social Security Institute could not depend on curative medicine alone, because to do so would encourage more hospitalizations or consultations.
Therefore, there are some programs that include both the curative and the preventive approach. An example is family planning, which is addressed in preventive as well as curative women's health programs and which cannot be seen as an isolated event that has no relationship with physiologic or pathologic problems. For this reason, a duplication of efforts has occurred throughout time in preventive and curative services. This tendency becomes stronger when services are decentralized and integrated into the communities. The strategy of developing local health services, is par excellence an integrative one. The Institute strongly encouraged this process, although at this time, furnishing health services through two institutions resulted in unnecessary duplication and cost. It is important to redefine as soon as possible the role of the Ministry of Health as the institution that determines coordinates actions, and evaluates results at the same time that the Social Security Institute implements all preventive and curative actions.
Finally, all these processes, and in particular those events that have occurred during the last 20 years, have been taking place with minimum legal changes. Therefore, it has become necessary to review the legal framework and make the wholesale changes that are required to improve the structure and function of the health care system. Without appropriate changes the exceptional process that has been developed in Costa Rica, will begin to deteriorate. It is important that the Social Security Institute not only eliminate negative factors that are becoming stronger, but also thee it allow the participation of organizations that have been excluded.