The problems affecting the Costa Rican Social Security System (CCSS) lie beyond financial difficulties, as they also include a serious management deficiency and bureaucratic gridlock that has turned the institution into an extremely rigid structure, unable to meet the needs and demands of the population with the promptness required. The CCSS is probably the largest “firm” in Central America; it employs approximately 55,000 people, of which 10% are medical professionals. It is the institution that sustains part of the social security which Costa Ricans enjoy today. However, its operation and thus its problems should be analysed linked to the concept of social production of health, as this is a social product.

Public health; Health services; Health determinants