Costa Rica: Management of Services

The health care reforms in Costa Rica in the early 1990s addressed many aspects of facility organization and management and included systematic measurement and data feedback loops for performance measurement and improvement. Costa Rica’s EBAIS teams (comprehensive care teams that provide primary care in facilities and communities) regularly collect relevant epidemiological data from communities through the Evaluacion de la Prestacion de Servicios de Salud (EPSS) evaluation. The indicators measured by the EPSS assess access to care, continuity of care, effectiveness, efficiency, and user satisfaction.1 After collection, these data are sent to the health area and then the CCSS authority who analyzes and returns the data to health areas and EBAIS teams. The results are used to assess performance against existing targets, define the next set of targets, and redirect resources to areas in need.2 If a Health Area falls within the lowest 20 percent, they work with the Department of Purchasing Health Care Services to create improvement plans. Thus, Costa Rica demonstrates how performance management systems can be used to identify gaps, collaborate on solutions, and improve. More detail on Costa Rica’s primary health care system can be found in this case study.


  1. Pesec M, Ratcliffe H, Bitton A, Ratcliffe Msc H, Director C. Building a Thriving Primary Health Care System: the Story of Costa Rica. 2017; Available from:
  2. Pesec M, Ratcliffe HL, Karlage A, Hirschhorn LR, Gawande A, Bitton A. Primary Health Care That Works: The Costa Rican Experience. Health Aff (Millwood). 2017 Mar;36(3):531–8.