Costa Rican social security fund"s alternative models : a case study of the cooperative-based, Coopesalud Pavas Clinic

This report documents the Social Security Fund"s motivation for developing this and several other alternative models of health care. It describes the organizational and administrative structure, personnel, and evolution of the Cooperative, and performs a provisional performance assessment of the Pavas Clinic, comparing it to other Social Security clinics of the same size and staff, i.e., other Type 4 Clinics. COOPESALUD is an alternative model of care which has a plethora of diverse goals and objectives. By many criteria, the cooperative model of care provided by COOPESALUD at the Pavas Clinic has been highly successful. These criteria include: patient satisfaction, access to care, level of service provision, coverage of target population, concentration of services, service mix (preventive versus curative), the apparent continuity of care, and the responsiveness of the Clinic to the health needs and desires of the community. In terms of the economic or financial success of the cooperative model, the picture is also very positive. COOPESALUD provides health care services at a significantly lower cost than a traditional Caja clinic. COOPESALUD provides care at about 70% of the cost of a Caja-run facility. Given its relatively higher levels of service provision and patient satisfaction, as well as its cost-effectiveness, the COOPESALUD model cannot but be regarded as a excellent alternative to the traditional Caja Type 4 Clinic. Extending or replicating the cooperative-based alternative model of care is a way by which the Caja could increase its own cost-effectiveness. (Author abstract)