COSTA RICA | Summary

In Costa Rica, the first major legislation towards health coverage was the Caja Costarricense de Seguro Social (CCSS) in 1941. It was a social security insurance system for wage-earning workers. Starting in 1961, the system was expanded to include dependents of these wage-earning workers. Until 1975, the CCSS extended coverage to people in rural areas, the low-income population, and certain vulnerable populations for primary care, outpatient care, and inpatient services. Coverage began to include farmers and independent contract workers in the late 1970s. Expansion efforts continued and more Costa Rican became eligible for CCSS. By 2003, insurance coverage through CCSS increased to 89%.⁸ In 2010, the Costa Rican government made it mandatory for residency applicants to become members of the CCSS.¹¹ With health care interpreted as a right, Costa Rica was able to reach universal health coverage.

 

Before 1995, the Ministry of Health was responsible for providing primary care and prevention services to the population. In 1995, primary health care became a nationwide priority, which led to the deconcentration of administrative responsibility. The responsibility of primary care and prevention was transferred to the CCSS, while the Ministry began to focus on national policy, planning, promotion, and coordination of all the public and private activities of healthcare. With the shift in priorities, the CCSS established the Primary Health Care Teams, or EBAIS. They are responsible for providing care and increasing access to care for all residents of Costa Rica. By the end of 2001, 80 percent of the population had access to these teams and nearly the entire population had access by 2006.⁸

 

Costa Rica has experienced different eras of overall health status because major sources of funding for the health system comes from large businesses, employers, and government institutions. Healthcare delivery and health outcomes change with the fluctuation of economic performance.⁹ From 1960 to 1980, Costa Rica experienced huge health improvements which placed the country as the 2nd best in Latin America for health indicators such as population coverage, infant mortality, life expectancy, and health services.¹⁰ However, during the economic crisis of the 1980s, the government had to cope with the financial difficulties, which affected health care. The recession showed the downturn in overall health because the government struggled to financially uphold medical services. There was a higher need for foreign aid and controversy arose about the worthiness of the health system.⁹ The government had to introduce programs to reduce costs and transform the model of health to maintain high health standards for Costa Rica in the future.¹⁰

Costa Rica is one of the few countries in Latin America that offers almost complete, universal coverage through the Caja Costarricense de Seguro Social (CCSS) in the public sector and has coverage options through the private sector as well. Although there is no direct constitutional right to health, the constitution does recognize that human life is inviolable. Through this article, the Court derived the right to health was guaranteed and constitutionally protected.¹² The CCSS is an autonomous institution, separate from the Ministry of Health, that is in charge of financing, purchasing and delivering most of the personal health services in Costa Rica. It provides these services in its own facilities but also contracts with private providers. The public healthcare system has a network of 30 hospitals and 250 clinics.¹⁰ Patients may experience long wait times with this system but will receive affordable care with adequate quality.¹⁴ The CCSS manages three different regimes for different populations consisting of the illness and maternity insurance(SEM), the disability, old age, and death regime (IVM), and the non-contributive regime.¹³ The SEM covers the wage-earning population and individuals that are financially dependent on that person.

 

The IVM provides coverage and pensions for old age, disability, orphanhood and widowhood. The non-contributive regime provides health insurance for individuals who are unable to contribute to the system such as low-income or disabled populations.¹² The CCSS is financed with contributions of the affiliates, employee-employer, and the state. The employee contribution is approximately 23% of each insured’s salary but the employer provides about 14% of that total. The State acts as its own contributing party as well as an employer for the public sector. The non-contributive regime is financed by the state through the Fund for Social Development and family welfare. There are also specific charges on electronic lottery activities and tobacco and liquor sales that contribute to the regime.¹²

The Ministry of Health is in charge of strategic planning, sanitary regulation, and research and technology development for the health system. The most recent policy innovation is the primary health care teams or EBAIS (Equipos Básicos de Atención Integral de Salud), which serve as the first point of contact for all health services.¹³ These teams consist of healthcare professionals such as a doctor, nurse and a public health worker. They are assigned to specific geographic regions and have played a prominent role in increasing access to care for vulnerable populations.⁸   

In Costa Rica, the government has a monopoly with private health insurance plans.¹⁵ The premiums for the health plans are determined by the income of each applicant, in which individuals with higher income pay more.¹² Around 30% of Costa Rica’s population possess a voluntary, private health plan.¹⁵ Although private health care is more expensive, it is still relatively low-cost and has great quality comparable to high income countries. Private health services are provided at private hospitals and ambulatory settings. It is common for physicians to work for the public CCSS in the morning and later see patients in their own practices or private facilities.¹¹ Due to the analogous level of medical quality to more-developed countries and the low cost of care, Costa Rica has become a popular spot for medical tourism.¹⁴   

Similar to many countries, Costa Rica is experiencing a continued epidemiological transition toward an increased burden of noncommunicable diseases and a demographic transition towards a larger, older population.⁸ The two major causes of death in the country are cardiovascular illness and cancer. The health system has strong primary care but struggles to meet the high demands of specialized treatment, especially in more rural areas. The lack of access to curative treatment has pushed more patients to the emergency room for care, which costs up to twice that of a primary care consultation.¹²  

HEALTH INDICATORS & DEMOGRAPHICS

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