Estado de bienestar y cambio: la transformación de las políticas públicas de salud en Costa Rica, (1990-2014)

Durante muchos años Costa Rica se ha reconocido por la construcción histórica de su Estado de bienestar, reconocido por el acceso igualitario y universal a la educación y la salud con avances significativos que le permite mantener indicadores de desarrollo humano en niveles comparados con los países desarrollados. Sin embargo, luego de la crisis internacional de 1980, que afectó fuertemente a Latinoamérica, Costa Rica, comenzó a sufrir una transformación en su modelo de desarrollo en un contexto de globalización neoliberal, en el que se fortalece cada vez más, el sector privado de servicios de bienestar, en especial, los servicios de educación y posteriormente, los dirigidos a la atención de la salud. Los servicios del Estado empezaron a sufrir recortes presupuestarios haciéndose más profundos dichos fenómenos a partir de la década de los 90́s en presencia de servicios públicos cada vez más deteriorados. Esta investigación explicará los cambios del Estado Costarricense por medio del estudio de las políticas públicas de salud establecidas a partir de 1990 y la transformación del sistema de salud, haciendo una construcción histórica de los principales acontecimientos y fenómenos desde una perspectiva del neo-institucionalismo histórico. El Ministerio de Salud, con la crisis de 1980 y la Reforma de 1990, se ve reducido en su función y presupuesto al ser trasladada a la Caja Costarricense de Seguro Social, los servicios de prevención de atención primaria, la cual debería ser asumida a partir de dicha reforma, con los recursos de las cuotas de cotización del seguro de salud. Los problemas de sostenibilidad financiera y una gestión política y administrativa que refleja lo expuesto en el enfoque de ¨ path dependence ¨ de las instituciones antes mencionadas, giraron alrededor de la crisis del sistema de salud, constituyéndose en uno de los principales temas relevantes del debate nacional. El deterioro de los servicios de salud, ha significado una oportunidad para el sector privado, donde los ciudadanos encuentran una opción para resolver sus problemas de salud, ante las largas listas de espera y la calidad del servicio, generado por problemas de infraestructura sumamente serios. La transformación del sistema de salud, conforme la teoría de sistema de salud, se resume en una financiación mayor del gasto privado, resaltando los gastos de bolsillo de los ciudadanos, ante la ausencia de un mercado de seguros. No obstante, con el Tratado de Libre Comercio, se espera en un futuro próximo, la consolidación de este mercado conjuntamente con un sector privado que ha diversificado todos sus servicios y ha visto crecer su demanda. Lo anterior, significa una variación en la prestación de servicios, que antes correspondían casi de manera exclusiva a la CCSS. Todo esto nos lleva a concluir sobre la transformación del sistema de salud que pasa de ser sostenido por las cuotas de la seguridad social a uno mixto con un alto componente de financiación y prestación de servicios privados. En ese nuevo contexto, la regulación es clave para garantizar una sana competencia de las empresas y la mayor información para los usuarios del servicio, sin embargo, Costa Rica refleja serias debilidades en esta regulación, por parte del Ministerio de Salud, cuya ausencia de rectoría encuentra dificultades ante una amplia gama de actores involucrados en las políticas de salud, que hace sumamente compleja las políticas públicas de salud. Los ciudadanos, reflejan una mayor preferencia hacia los servicios privados de la salud, ante las débiles políticas públicas que se desarrollan en el intento estatal de fortalecer su sistema de salud frente a una creciente mercantilización de los servicios de salud en Costa Rica, con riesgos de una ruptura de los principios solidarios y universales del Estado de Bienestar Costarricense

Redescription of Anomala eucoma Bates, 1888 and a description of three new species from Costa Rica (Coleoptera: Scarabaeidae: Rutelinae)

Anomala eucoma Bates, 1888 is redescribed and a lectotype from Guatemala is designated. Three new species from Costa Rica, A. flavacoma new species, A. megaparamera new species, and A. pseudoeucoma new species, are described, and a distribution map is given. The internal sac (endophallus) of the species covered is illustrated, and its use in separating closely related species in this region is discussed. An identification key for morphologically similar species from the Neotropical region is provided.

Description of eight new Anomala species from Costa Rica (Coleoptera: Scarabaeidae: Rutelinae)

Eight new species of Anomala from Costa Rica are described: A. arthuri new species, A. cupreovariolosa new species, A. ferrea new species, A. nigroflava new species, A. semilla new species, A. solisi new species, A. volsellata new species, A. zumbadoi new species and a distribution map of each is given. The male genitalia (aedeagus and endophallus) of the species covered are illustrated.

The genus Callistethus (Coleoptera: Scarabaeidae: Rutelinae) in the Neotropics: new data and new species from Costa Rica

The species Callistethus carbo sp.n., C. flavodorsalis sp.n., C. fuscorubens sp.n., C. lativittis sp.n., C. levigatus sp.n., C. macroxantholeus sp.n., C. microxantholeus sp.n., C. multiplicatus sp.n., C. parapulcher sp.n., C. pseudocollaris sp.n. and C. stannibractea sp.n. from Costa Rica are described. Synonymy of Callistethus kolbei (Ohaus, 1897) with Callistethus specularis (Bates, 1888) is proposed. A phylogenetic analysis based on the genes 16S, COI and 28S is carried out for Costa Rican species and diagnostic morphological features for the genus are tested on it for phylogenetic signal. An identification key for Callistethus species of Costa Rica is provided. The distribution patterns of Callistethus species in Costa Rica are discussed.

Description of two cryptic species of Anomala Samouelle (Coleoptera: Scarabaeidae: Rutelinae) from Costa Rica

Two new species of Anomala Samouelle from Costa Rica are described: Anomala moroni new species and A. parvaeucoma new species. Habitus, protibia, distribution map, and male genitalia (aedeagus and endophallus) of each species are illustrated. A key for the dorsally setose species from the Neotropical region is provided.

On the batrachia and reptilia of Costa Rica : With notes on the herpetology and ichthyology of Nicaragua and Peru / by E. D. Cope.

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On the batrachia and reptilia of Costa Rica : With notes on the herpetology and ichthyology of Nicaragua and Peru / by E. D. Cope.

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An annotated list of fishes known to occur in the fresh waters of Costa Rica.

v.10:no.10(1914)

New species of fishes from Costa Rica.

v.10:no.7(1912)

Factors Affecting Jaguar and Puma Predation on Livestock in Costa Rica

The wild cats and the livestock farmers are part of the space conflict in the rural areas in Latin America. In this sense, this conflict causes a discomfort among the livestock producers due to the loss of animals and, consequently, it also causes a negative reaction towards the wild cats leading such reaction into the elimination of the wild cats per se. Although, there have been some initiatives have tried to approach such conflict by recommending mitigation and prevention measurements to the producers, these measurements are undertaken without coordination. For this reason, the following project presents a planning tool that can ease the coordination processes undertaken for the solving of the conflict between human beings and wild cats.

Lithium isotopic composition of pore fluids and sediments in the Costa Rica subduction zone

Pore fluid and sediment Li concentrations and isotopic ratios provide important insights on the hydrology, sediment contribution to the arc volcanoes and fluid-sediment reactions at the dominantly non-accretionary Costa Rica subduction zone. Ocean Drilling Program Site 1039 in the trench axis provides a reference section of 400 m of the incoming sediments, and Site 1040, situated arcward from the trench, consists of a deformed sedimentary wedge and apron sediments, the décollement, and the partially dewatered underthrust sediment section. At the reference site, pore fluids show important isotopic variations (delta6Li=-21.7 to -37.8 per mil), reflecting the interplay of in situ alteration of volcanic material and ion exchange with clay minerals. In the basal section, a reversal of Li concentration and delta6Li toward seawater values is observed, providing supporting evidence for a lateral seawater flow system in the upper oceanic basement underlying this sediment section. At Site 1040, pore fluid of the lower deformed wedge sediments and within the décollement is enriched in Li and the isotopic compositions are relatively light, suggesting infiltration of a deep-seated fluid. The delta6Li value of -22 per mil of this Li-enriched fluid (261 µM), when compared with the delta6Li value of the subducted sediment section (-11 per mil), suggests that the deep source fluid originates from mineral fluid dehydration and transformation reactions at temperatures of 100 to 150°C, consistent with the temperature range of the up-dip seismogenic zone and of transformation of smectite to illite. The distribution of Li and its isotopes in the underthrust section are similar to those at the reference site, indicating near complete subduction of the incoming sediments and that early dewatering of the underthrust sediments occurs predominantly by lateral flow into the ocean. The hemipelagic clay-rich sediment section of the subducting plate carries most of the Li into this subduction zone, and the pelagic diatomaceous and nannofossil calcareous oozes contain little Li. The Li isotopes of both the clay-rich hemipelagic sediments and of the pelagic oozes are, however, similar, with delta6Li values of -9 to -12 per mil. The observations that (1) the delta6Li values of the underthrust sediments are distinctly lower than that of the mantle, and (2) the lavas of the Costa Rican volcanoes are enriched in Li and 7Li, provide an approximation of the contribution of the subducted sediments to the arc volcanoes. A first order mass balance calculation suggests that approximately half of the Li flux delivered by subducted sediments and altered oceanic crust into the Middle American Trench is recycled to the Costa Rican arc and at most a quarter of sedimentary Li is returned into the ocean through thrust faults, primarily the décollement thrust.

(Table 1) Sr-isotope values of representative sediment samples from ODP sites at the Costa Rica margin

Two sealed borehole hydrologic observatories (CORKs) were installed in two active hydrogeochemical systems at the Costa Rica subduction zone to investigate the relationship between tectonics, fluid flow, and fluid composition. The observatories were deployed during Ocean Drilling Program (ODP) Leg 205 at Site 1253, ~ 0.2 km seaward of the trench, in the upper igneous basement, and at Site 1255, ~ 0.5 km landward of the trench, in the décollement. Downhole instrumentation was designed to monitor formation fluid flow rates, composition, pressure, and temperature. The two-year records collected by this interdisciplinary effort constitute the first co-registered hydrological, chemical, and physical dataset from a subduction zone, providing critical information on the average and transient state of the subduction thrust and upper igneous basement. The continuous records at ODP Site 1253 show that the uppermost igneous basement is highly permeable hosting an average fluid flow rate of 0.3 m/yr, and indicate that the fluid sampled in the basement is a mixture between seawater (~ 50%) and a subduction zone fluid originating within the forearc (~ 50%). These results suggest that the uppermost basement serves as an efficient pathway for fluid expelled from the forearc that should be considered in models of subduction zone hydrogeology and deformation. Three transients in fluid flow rates were observed along the décollement at ODP Site 1255, two of which coincided with stepwise increases in formation pressure. These two transients are the result of aseismic slip dislocations that propagated up-dip from the seismogenic zone over the course of ~ 2 weeks terminating before reaching ODP Site 1255 and the trench. The nature and temporal behavior of strain and the associated hydrological response during these slow slip events may be an analog for the response of the seaward part of the subduction prism during or soon after large subduction zone earthquakes.