A newly surfaced internal audit at the Caja Costarricense de Seguro Social (CCSS) has intensified scrutiny of Costa Rica’s public healthcare system, and it has now drawn a formal demand for answers from the Legislative Assembly. Deputy Ángela Aguilar Vargas, of the Partido Liberación Nacional, has written to CCSS executive president Mónica Taylor Hernández requesting a detailed explanation of the findings and of the corrective measures the institution intends to take.
The document at the center of the dispute is the internal audit advisory cataloged as AS-ASALUD-0057-2026, dated June 3, 2026, which compiled the principal findings of a series of audits conducted between 2022 and 2025. According to that report, as of March 2026 the Caja carried 1,440,547 registered cases on its waiting lists.
That headline figure is easily misread by anyone accustomed to comparing it against a national health service abroad, so it warrants a careful reading: it is the combined total of three separate lists rather than a count of 1.44 million distinct individuals. A single insured person waiting for a specialist appointment, a diagnostic procedure and an operation can appear on all three at once, and official reporting uses the words “patients” and “cases” interchangeably.
The three lists break down as follows in the audit’s most recent snapshot. Roughly 204,622 people were awaiting surgery, some 362,356 were waiting for a specialty outpatient consultation, and the largest category by far, medical procedures, accounted for about 873,572 pending cases. The procedures list is where the backlog has grown most sharply, and it is the category that most distorts the topline number for readers who assume “waiting list” means “waiting for an operation.”
The audit’s central conclusion is not simply that the lists are long but that they are growing despite a dedicated plan to shrink them. Comparing December 2024 with March 2026, the report found the combined lists rose from 1,094,093 to 1,440,547 cases, an accumulated increase of 346,454 people, or 31.7 percent, over that roughly fifteen-month span. The auditors traced the persistent backlog to a shortage of medical specialists and nursing staff, the underuse of operating theatres, deficiencies in how the institution manages its own data, and problems of coordination across the hospital network.
Those failures are measured against a specific commitment. In May 2023 the CCSS board of directors approved what it called a roadmap to advance the management of waiting lists and of specialized health personnel, and it declared the matter an institutional emergency. The current audit concludes that the roadmap’s targets were not met, attributing to the administration a direct responsibility for the lack of effective results and pointing to weaknesses in the planning, execution and follow-up of the measures adopted.
It is on that basis that Aguilar has pressed the executive presidency for answers. In her letter she posed four questions: what corrective and complementary actions the administration will implement in response to the audit’s observations; what immediate steps it will take to relieve the bottleneck in specialized outpatient consultation; how it will ensure administrative accountability so that the shortcomings identified are not repeated; and which specific actions have already been set in motion on the audit’s recommendations, together with any preliminary results.
The deputy framed the stakes in human terms, stating in a translated remark that the deterioration shows the 2023 roadmap measures went unfulfilled, with serious consequences for users who face delays that harm their quality of life and allow their conditions to worsen.
The CCSS has publicly acknowledged the scale of the problem in recent months. Taylor has described the waiting lists as extremely difficult to reduce in the short term and has pointed to a strategy of strengthening emergency services to decongest hospitals, while the board earlier this year approved a new multi-year plan intended to distribute resources more evenly across the system. At the time of writing, the executive presidency had not issued a public response to Aguilar’s specific letter.
For the roughly five million people insured through the Caja, including foreign residents, retirees and residency applicants who pay monthly contributions and depend on the system for their care, the audit is less a single alarming statistic than a measure of how long the wait for specialist attention, diagnostics and surgery has become, and of whether the institution’s repeated promises to fix it are producing results.
