Costa Rica’s public health system is again weighing a move that would have seemed unthinkable a few years ago: paying private doctors directly to help relieve pressure inside the CCSS. The latest proposal would allow some patients to receive care from private physicians when the public system cannot offer a timely appointment.
The version now under discussion is focused first on general medical appointments for patients who cannot get a slot at an Ebáis, with the CCSS covering the full cost under pre-set rates. Recent reporting says the plan is being designed as a limited pilot in the Greater Metropolitan Area and would not use a copayment model.
The proposal is part of a broader push inside the CCSS to find faster ways to chip away at long waitlists that have become one of the country’s biggest healthcare problems. In a board session in Feburary, Medical Manager Alexander Sánchez said the institution’s 2026 waitlist plan would have to include a new payment model as officials decide how to address the backlog. That same session also referenced payment-by-results models for certain services, including trauma care, hemodynamics, electrophysiology and urgent radiology readings.
The pressure behind that shift is growing. Costa Rica has put the number of patients stuck in CCSS waitlists at roughly 1.25 million to 1.3 million across surgeries, specialist consultations and diagnostic procedures. One January report said about 200,000 people were waiting for surgery alone, with average waits exceeding a year.
The specialist shortage is a major part of the problem. In February that 241 specialists had left the CCSS since August 2024, though the institution had hired 208 over that same period. The loss translated into more than 85,000 specialist hours, affecting consultations, surgeries and inpatient care.
This is not the first time the Caja has explored outsourcing part of the response. A 2025 internal audit found that several measures announced earlier to tackle waitlists were still pending long after their original deadlines, including copayment, public-private alliances, second shifts and the use of private providers for studies. The same audit said progress on the roadmap had reached 52%, but without the substantial drop in waitlists the institution had promised.
What makes the current plan politically sensitive is that the CCSS is trying to draw a line between temporary support from the private sector and a deeper structural shift away from public provision. Reporting this week says the proposal would be limited, fully financed by the institution, and aimed at low- and medium-complexity cases rather than long-term management of chronic patients. Officials involved in the discussions have argued the idea is to complement public capacity, not replace it.
Even so, the debate is likely to intensify. Costa Rica’s healthcare system remains one of our country’s most valued public institutions, and any move that sends insured patients into private offices raises immediate questions about equity, oversight, continuity of care and the long-term direction of the CCSS. At the same time, the scale of the backlog is making it harder for decision-makers to argue that internal fixes alone will be enough in the near term.
For now, the proposal appears to be in development rather than execution. Recent reporting says the design, architecture and any needed regulatory changes are expected to be worked out by September before the initiative could go to the board for approval. That means the discussion is no longer about whether the CCSS should consider outside help, but how far it is willing to go to bring waiting times down.
