The Business Year

Dr. Roman Macaya

COSTA RICA - Health & Education

Toward Better Outcomes

Executive President, Costa Rican Social Security Fund (CCSS)


Dr. Roman Macaya serves as Executive President of the Costa Rican Social Security Fund, which finances and provides universal public healthcare services in Costa Rica and manages the largest pension system of the country. Dr. Macaya has held this position since August 1, 2018. Prior to this, he served as Costa Rica’s Ambassador to the US from 2014-2018. He has developed a multidisciplinary career as a biomedical scientist, businessman, advocate, politician, academic, diplomat, and public servant. He holds an MBA in healthcare management from the Wharton School of Business (University of Pennsylvania), a PhD in biochemistry from UCLA, and a BA in chemistry from Middlebury College.

CCSS strives to ensure every citizen in Costa Rica receives healthcare coverage regardless of their age, income bracket, geography, or disease.

What is your take on the current state of the health sector in Costa Rica?

Costa Rica enjoys the health indices of developed nations in terms of infant mortality, longevity, the incidence of chronic diseases versus infectious diseases, and so forth. We went in a few decades from relatively low life expectancy to high, and from high fertility rates to low, and we are seeing the consequences of that in terms of utilization of healthcare services, whether for in-patient care, out-patient care, or pharmaceutical consumption. It is a challenging time, as we have to care for an aging population, though also an exciting one as we are in the process of updating technology and expanding infrastructure throughout our system to be able to deal with this. With new technological developments in informatics, medical equipment, and scientific understanding of disease, we are in a position to have a greater impact on the health of our population.

What should be the public and private healthcare mix in the Costa Rican system?

Our role as a public institution is to meet the constitutional mandate in Costa Rica where every citizen has a constitutional right to health. This is a major challenge as it involves any procedure that has a clinical benefit, while drugs that have been shown to have a high efficacy should also be covered by the system. Every system has its strengths and weaknesses; our strengths are coverage as pretty much everyone is covered in terms of age, income bracket, and geography, as well as virtually against any disease that has a treatment. It also means that in a system of universal healthcare coverage with no limits on what diseases are covered and with no exclusions, demand is growing at a rapid pace as our population ages and the expectations of our citizens increase. The challenge is to care for all these patients on a timely basis, which is why we are building greater capacity from an infrastructure, technology, and human capital perspective. Sustainability is a major issue, as we need to remain efficient and be able to make the most rational decisions on what type of services and medicines will be the most cost effective in treating our population. We have a luxury system in that everything that can be clinically justified is covered. The private sector has been filling in the gaps where the public sector has not met the expectations of the population on a timely basis.

What are the main priorities and objectives of your current agenda?

We need to establish an innovative approach to healthcare. Demand for healthcare services is set to outpace the growth of our economy due to our aging population. We need to innovate so that we can care for these patients in a more cost-effective manner using evidence-based medicine to the greatest extent and by understanding the protocols and procedures that are most effective, which includes promoting preventive medicine. Secondly, we want to update medical technology and have state-of-the-art equipment in our hospitals, whilst also upgrading our physical infrastructure through renovations or new facilities. There are new projects such as in-vitro fertilization that we hope to offer our citizens starting in June. Another major priority with numerous components that we need to accomplish is to reduce waiting times for elective procedures, whether for elective surgeries or diagnostics, as waiting times are always a top priority among patients. We need to promote a culture of innovation, where leaders in our healthcare system are willing to re-invent how we do things. To this end, we will take full advantage of our latest tool in Caja’s toolbox, our newly implemented electronic record system EDUS. For the first time since 1941, we have an electronic record system where medical records can be brought up at any of our clinics or hospitals in the country.



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