Management commitments and primary care: another lesson from Costa Rica for the world?

摘要: Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than decade, management commitments have been part of Rican reform. We assessed the effect on access and quality compliance their intended objectives. constructed seven hypotheses opinions providers. Through mixed qualitative quantitative approach, we tested these interpreted research findings. Management consume an excessive proportion consultation time, inflate recordkeeping, reduce comprehensiveness consultations, induce disproportionate consumption hospital emergency services. Their formulation relies norms need optimization, control unreliable sources. They also affect professionalism. In Rica, negatively pose threat service system. The failures this pay-for-performance-like initiative otherwise well-performing cast doubts appropriateness pay-for-performance for systems strengthening less advanced environments.