5049.0: Wednesday, November 15, 2000 - Board 4

Abstract #15672

Monitoring and evaluation when contracting for health service delivery in Costa Rica

Wendy B. Abramson, MPH, IHA, Abt Associates Inc, 4800 Montgomery Lane. Suite 600, Bethesda, MD 20814, 301-718-3192, wendy_abramson@abtassoc.com

The Costa Rican Social Security Fund (CCSS) has been purchasing primary health care services from the Costa Rican Cooperative, COOPESALUD. After laying out a general framework for developing performance indicators, this presentation analyzes the CCSS's evaluation of its contract with COOPESALUD in terms of objectives, performance indicators, evaluation results, and the use of the evaluation results. The objectives of the COOPESALUD contract are to increase coverage, improve quality, and increase efficiency. Contract performance is measured through three categories of indicators: organization, service delivery, and quality. Service delivery targets are set in terms of volume of services based upon geographic population. Organization and quality targets are scored by using either a "yes" or a "no" rating to indicate whether a particular system is in place. By setting indicator targets based upon population estimates, it is difficult for the CCSS to accurately assess COOPESALUD's performance. Although the CCSS conducts periodic evaluations through formal mechanisms, and some data on volume of service delivery is available, the data gathered in all three categories do not provide the purchaser with information directly related to all of the contract objectives nor to contractor performance. The indicators spelled out in the contract and the evaluation of those indicators do not seek to measure quantifiable results or impact through numerical data. There are no process or result indicators in place. The evaluation results could therefore tend to be fairly superficial--based upon population coverage and not on effectiveness of treatment, quality of treatment or efficient resource use.

Learning Objectives: 1. State the framework used to analyze the COOPESALUD/Costa Rican contract performance evaluation process and data; 2. Identify the categories of performance indicators contained in the contract; 3. Discuss the evaluation results and recommendations for improvement of this monitoring and evaluation system

Keywords: Contracting, Evaluation

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Costa Rican Social Security Fund and the Costa RIcan Cooperative COOPESALUD
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA