Excessive wage bills pose a threat to the wider social fabric. The Survey also noted that “rising public sector salaries made the largest contribution to inequality between 2010 and 2014, particularly salaries of qualified workers in public agencies outside central government” - such as the CCSS (OECD, 2016a). As noted in Section 1, for example, obesity rates are higher in Costa Rica than most OECD countries. In most OECD health systems, the central budgetary authority (e.g. the Ministry of Finance) sets expenditure ceilings for the health sector, annually or over multi-year cycles.