Costa Rica’s public health system is facing another increase in surgical delays, with 204,622 insured patients waiting for an operation through the Caja Costarricense de Seguro Social (CCSS)as of April 2026.
The figure is up from 190,076 patients a year earlier, adding more than 14,500 people to one of the country’s most persistent public health problems. The increase means the surgical waitlist grew by roughly 8% in a year, even as the CCSS continues to promote new plans to reduce delays and improve patient flow.
The backlog matters across the country, but it carries a particular weight for foreign residents, retirees, and expats who depend on the public system for regular medical care. Many legal residents are enrolled in the CCSS and use Caja hospitals and clinics for primary care, prescriptions, specialist appointments, and surgeries. Long waits often become part of the calculation when deciding between staying fully in the public system, paying out of pocket for private treatment, or carrying private insurance as a backup.
The latest figures show that patients waiting for surgery face an average delay of 441 days. A year earlier, the average wait was 428 days, meaning the backlog is not only larger but slightly slower. Some cases face even longer delays, depending on the specialty, hospital capacity, available specialists, and operating room access.
Orthopedics remains one of the hardest-hit areas. More than 34,000 orthopedic surgery cases are pending, with waits that can stretch well beyond a year. General surgery also carries a major load, with more than 54,000 people waiting. Surgical oncology has a smaller list, with about 1,300 pending cases, but delays in cancer-related care remain especially sensitive because of the risks involved in postponed treatment.
The problem extends beyond surgery. More than 362,000 patients are waiting for specialist consultations, while hundreds of thousands more are waiting for outpatient procedures and diagnostic services. That includes exams such as colonoscopies, cataract screenings, cardiology procedures, imaging, and other tests that often determine whether a patient needs further treatment.
The CCSS has approved a 2026–2030 plan aimed at cutting delays in surgery, specialist care, and diagnostic procedures. The strategy includes extraordinary work shifts, better use of available hospital capacity, payment by results for some procedures, and technology to update patient records more quickly.
One part of the plan uses artificial intelligence to help clean up waitlist records. The system is designed to flag cases where a patient may no longer need the procedure, may have been treated elsewhere, cannot be reached, has a medical contraindication, or has died. CCSS officials have said patients will not be removed automatically and that human review will remain part of the process.
The institution says the goal is to focus resources on patients who still need care and avoid losing time on outdated records. Between 2023 and the first quarter of 2026, the CCSS resolved more than 367,000 patients from the surgical waitlist and removed more than 136,000 cases that no longer required surgical resolution.
Still, the latest totals show the system continues to receive more demand than it can clear. The CCSS is dealing with limited specialist availability, pressure on emergency services, operating room constraints, and years of accumulated delays that worsened during and after the pandemic.
For residents using Caja, routine care and medications through the public system can still be a major benefit, but surgery and specialist care may involve long waits. Patients with time-sensitive conditions often need to monitor their cases closely, keep records updated in EDUS, respond to CCSS calls or messages, and ask their clinic or hospital about escalation options when symptoms worsen.
The rising waitlist also keeps pressure on Costa Rica’s next health policy decisions. The CCSS remains one of the pillars of our country’s social model, but the numbers show a system under strain. For many people, the question is no longer whether Caja provides access to care. It is how long that access takes when the care needed is a surgery, a specialist appointment, or a test that cannot wait forever.
