The capacity of public health services is determined by the CCSS. Those negotiations and agreements are held by the central level of the CCSS and the regional and local level within the institution. The capacity is being analyzed considering the health service networks. Its amelioration requires in some cases new resources, as well as an important optimization in the reference and counter reference system of patients and to improve de efficiency in resource utilization. The Ministry of Health does not participate in defining any of these aspects; nonetheless all hospitals must get a licensed to operate, the license issued by the Ministry of Health.