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close this bookThe Nutrition and Health Transition of Democratic Costa Rica (International Nutrition Foundation for Developing Countries - INFDC, 1995, 228 pages)
View the document(introductory text...)
View the documentContributors to this volume
View the documentIntroduction
close this folder1. Health policies and strategies
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View the documentA brief description of Costa Rica
View the documentPublic health development
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentFinal reflections
View the documentReferences
close this folder2. Development of the social security institute
View the document(introductory text...)
View the documentBackground
View the documentSocial security in Costa Rica
View the documentThe extension of direct insurance
View the documentExtension of insurance to the family
View the documentThe financial crisis
View the documentThe constitutional amendment
View the documentToward universalization
View the documentDevelopment of human resources
View the documentThe integration
View the documentThe new health care models
View the documentFinal comments
close this folder3. Development and characteristics of health and nutrition services for urban and rural communities of Costa Rica
View the document(introductory text...)
View the documentIntroduction
View the documentBackground information on community outreach programs
View the documentMethodological characteristics of the Costa Rican health programs
View the documentNutrition programs
View the documentImpact of the programs on the health of children living in rural areas
View the documentConclusions
View the documentReferences
View the documentBibliography
close this folder4. Evolution of an epidemiological profile
View the document(introductory text...)
View the documentIntroduction
View the documentStages of a process
View the documentThe first four decades of the century
View the documentThe period between 1940 and 1970
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentThe last decade of the century
View the documentFinal comments
View the documentReferences
close this folder5. Socioeconomic factors for the understanding of health policy during the 1970s
View the document(introductory text...)
View the documentIntroduction
View the documentRecognition of social demands and the regulation of the conflict during the 1930s and 1940s
View the documentThe social government in the new development strategy of Costa Rica during the 1950s and 1960s
View the documentThe consolidated social government
View the documentFinal reflections
View the documentAcknowledgement
View the documentReferences
close this folder6. Problems and challenges of the health sector during the 1980s
View the document(introductory text...)
View the documentIntroduction
View the documentSome problems of the health sector in the 1980s
View the documentBalance of the 1980s and perspectives for the 1990s in the health sector
View the documentReferences
View the documentAppendix 1 - Glossary
close this folderAppendix 2 - Supplementary reading list
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View the documentEnglish-language supplementary reading list
View the documentSpanish-language supplementary reading list
View the documentSupplementary reading list - INCAP publications
close this folderAppendix 3 - Health conditions in Costa Rica 1994
View the documentGeneral information
View the documentSpecific health problems

The integration

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.