Clinica Tibas: an experimental response to health system challenges in Costa Rica

Several experiments in health services delivery featuring contractual arrangements between government and the private sector have been initiated in Costa Rica. This report describes a public-private partnership serving a community of 50,000. A 'cooperative' of providers stands to gain financially if it succeeds in providing clinic services in an efficacious and efficient manner. This experimental approach retains elements of the existing public system for health promotion and disease prevention while introducing innovations for increased organizational efficiency and client satisfaction. The clinic provides easier access to better care, including ambulatory surgery, pharmacy service, and home visits, and at a lower cost to government than that budgeted under pre-existing arrangements. Inappropriate usage of area hospitals has been reduced; and a commitment to community participation and organized programming permit greater responsiveness to community needs. Those served by the clinic report satisfaction. Personnel also report satisfaction and enthusiasm for their work. Issues concerning extension of this model are considered.