Plans to collect regional variation in stage at diagnosis of cancer have been set out as part of the national cancer registry, but these data are not yet available for analysis (Ministerio de Salud de Costa Rica, 2016b). While standards and protocols were found to be in place, there were no systems in place to measure and track quality on a routine basis, nor to track the evolution of quality indicators over time at the time of the evaluation. Hospital infections doubled between 2000 and 2005, again with important differences amongst facilities. Dissatisfaction with perceived quality may also be an issue; more than 40% of the population report being dissatisfied or very dissatisfied with the quality of health sendees in 2014 (LAPOP 2014 as cited in Prat and Beverinotti, 2016, p. 72).