The CCSS recently established quality monitoring programme in primary care (see Section 1), with plans to develop a similar programme for hospitals. Not enough is known about the quality and outcomes of care in Costa Rica. Although some important initiatives are underway, such as the primary care performance monitoring framework, quality does not emerge as the dominant governing idea within Costa Rican health care. “ Quality” is still thought of in limited terms (typically, waiting times) meaning that important gaps in the health system’s information infrastructure persist. Even though there is a national cancer observatory, for example, authorities were unable to produce data on the stage of cancer at diagnosis (vital for understanding the effectiveness of screening and prevention programmes) when asked.