In the 1980s, for example, the CCSS contracted co-operatives in order to provide health care services in areas where there was a shortage (Saenz et al., As of 2016, four co-operatives and two non-cooperatives (the ASEMECO association and the University of Iberoamerica) provided health care services to 15% of the Costa Rican population on the basis of primary' level contracts (as earlier described). In case of need for specialised care, these providers should refer the patients to the secondary and tertiary level within the public health care network.