Respected British medical journal The Lancet recently published a comprehensive article about the three factors affecting our public health care system and how La Caja is dealing with them. The author of the article is David Boddiger, an experienced journalist who is also the editor of The Tico Times.

In his detailed article, Boddiger cites the global economic crisis, along with careless spending and mismanagement as the reasons why La Caja is in the precarious positions it finds itself in today. He cites that the alarm was sounded back in July of 2009, when La Caja noticed an $18 million shortfall in monthly contributions and the government. Two years later, an ominous report from the Pan American Health Organization indicated that La Caja would not be able to sustain itself financially past the year 2015.

The way the government and La Caja have reacted to the crisis is very similar to how a modern business would tackle an insolvent period. The government has vowed to introduced fiscal measures to collect taxes from every source imaginable to destined to La Caja: from sales of cigarettes and alcohol, new tolls, wealthy households, corporations, professional services, and others. On La Caja’s part, austerity measures have been drastically implemented; starting with a sharp reduction in salary raises, curtailed spending and increasing the workloads of existing staff to meet the rising demand of medical services among residents of Costa Rica.

According to Ileana Balmaceda, the highest executive at La Caja, the reduced budgets, lowered spending and restructuring that will take place over the next few years will stabilize the crisis by 2015. The efforts have begun, and they have already ruffled a few feathers.

Austerity Measures in Grecia

In the last few years, the municipality of Grecia in the province of Alajuela has grown from a sleepy agricultural community to a busting community where car sales and private doctor’s offices compete with coffee and sugar cane plantations for the number one economic activity.

This pretty city, named after the Mediterranean isle of Greece and once voted the cleanest in Latin America by an international consortium of municipalities, has fallen victim to austerity measures where it hurts the most: at its public hospital. Just like its namesake nation, the city of Grecia had been forced into accepting the consequences of financial constraints. When La Caja announced a plan to cut overtime hours and payment for time served by physicians on-call, at least a dozen doctors went on strike and threatened to quit.

The doctor’s strike in Grecia has polarized the community. Some people have called the physicians greedy, while others are urging La Caja to listen to their demands. Indignant Ticos have called upon La Caja to fire the doctors and replace them, while others have insinuated that if the physicians don’t like it, they should go sell cars down the road from the hospital.

La Caja has ordered the hospital to work around the strike for the time being. According to online news site Costa Rica Hoy, the hospital in Grecia has called on physicians from neighboring public health facilities to step in and volunteer their time, but it seems that the hospital is still stretched too thin and tragedy has already ensued.

According to El Pais, a pregnant woman with pre-eclampsia was admitted on Friday after 4:00 pm, at which time there was only one gynecologist on duty and no anesthesiologist on call. There are not enough funds to pay the anesthesiologist to stick around, and thus an emergency cesarean delivery was delayed one hour. The baby is now in serious condition at the Children’s Hospital in San Jose.

In the meantime, the problems for La Caja will probably continue, as explained by David Bodigger in The Lancet. The elderly Tico population is bound to increase, and the need for public health services is set to climb accordingly. An article published by The Costa Rica Star in the past has looked at the aging Tico population and the decreased birthrate, two demographic factors that stand in the way of La Caja’s recovery.