[Waiting lists and waiting times in Costa Rica: proposal for a conceptual framework]

Costa Rica's health system, which is predominantly public and organized under the National Health System, has achieved significant progress in health coverage and outcomes. Nevertheless, it continues to face persistent challenges related to waiting lists and waiting times for specialized care. Despite sustained progress toward universal coverage, approximately 10% of the population -particularly in rural areas- remains uninsured, resulting in gaps in effective access to healthcare services. Between 2019 and 2024, records from the Costa Rican Social Security Fund (Caja Costarricense de Seguro Social) show substantial increases in the number of individuals awaiting outpatient procedures, surgical interventions, and specialist consultations, as well as significant rises in waiting times. This situation contrasts with the existence of underutilized installed capacity during regular working hours, raising questions about the effectiveness and coherence of strategies that rely primarily on overtime sessions as the main institutional response. This article develops a theoretical framework for addressing waiting lists that explicitly incorporates the principles of equity, human rights, ethics, and distributive justice. From this perspective, waiting lists are understood as a social justice issue that disproportionately affects populations in situations of greater vulnerability. The article also reviews economic approaches to the problem and concludes that the sustainable reduction of waiting lists and waiting times requires a systemic, transparent, and ethically grounded approach.