Healthcare in Costa Rica

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Life expectancy in Costa Rica Life expectancy in Costa Rica.svg
Life expectancy in Costa Rica

Costa Rica provides universal health care to its citizens and permanent residents. [1] Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO's 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. [2] In addition, the UN (United Nations) has ranked Costa Rica's public health system within the top 20 worldwide and the number 1 in Latin America.

Contents

The Human Rights Measurement Initiative [3] finds that Costa Rica is fulfilling 94.7% of what it should be fulfilling for the right to health based on its level of income. [4] When looking at the right to health with respect to children, Costa Rica achieves 97.7% of what is expected based on its current income. [4] In regards to the right to health amongst the adult population, the country achieves 94.8% of what is expected based on the nation's level of income. [4] Costa Rica falls into the "fair" category when evaluating the right to reproductive health because the nation is fulfilling 91.7% of what the nation is expected to achieve based on the resources (income) it has available. [4]

Costs

In the early 1970s, the Ministry of Health was heavily subsidized by foreign aid. By 1977, health programs had been so successful that US Aid for International Development in the sector was ended, as the country was found "too healthy" to continue being a recipient. [5] In 2001, total spending on health care was 7% of GDP, with 3/4 of that being the public sector. [6] Currently, costs tend to be much less than doctor, hospital, and prescription costs in the U.S. [7] The country spends one tenth as much per capita on health care as the United States, focusing on preventive care. [8]

Public

Costa Rican Social Security Fund Logo CCSS - Costa Rica.gif
Costa Rican Social Security Fund Logo

The Costa Rican Social Security Fund or Caja Costarricense de Seguro Social (as it is known in Spanish) is in charge of most of the nation's public health sector. Its role in public health (as the administrator of health institutions) is key in Costa Rica, playing an important part in the state's national health policy making. Worker and employer contribution are mandated by law, under the principle of solidarity. Workers need to be cover by a "poliza de riesgo del trabajo" an insurance policy that complements the health care provided by the "Caja" for injuries related to labor risks.

Caja services are guaranteed to all residents, including the uninsured. [9] In 1989 this was expanded to include undocumented immigrants as well, which constituted up to 8% of the population at the time. The percent of residents with health insurance increased gradually, as the program was originally only intended for urban workers. It was not until 1961 that universal mandatory coverage became a stated goal. [6] After reaching a peak of 92% coverage in 1990, rates have remained around 88%. 12% of the insured are low-income residents who are eligible to have their coverage paid entirely by the state, based on a means-test. 87% of the uninsured enter a hospital via the emergency room, compared to only 58% of the insured. [9]

Emergency care is provided free of charge to all residents. [9] This governmental entity's functions encompass both the administrative and functional aspects. It has the obligation (as a public institution) to formulate and execute health programs that are both preventive (such as: vaccination, informational, fumigation, etc.) and healing (such as: surgery, radiation therapy, pharmacy, clinical, etc.) in nature. [10] Services "are aimed disproportionately" toward underprivileged Nicaraguan and Colombian immigrants and indigenous communities. [2] Spending is relatively progressive, with the poorest quintile receiving 29% of spending while the richest quintile only receives 11%. [6]

In 2000, 90% of the country's doctors were employed by the public sector, but 1/3 of those also maintained a private practice. [6] During the decade of the 1990s the percentage of all medical staff (not just doctors) who worked in the private sector increased from 10% to almost 25%. [9] As more doctors opt for the more profitable field of private practice, especially in relation to medical tourism, the government has resorted to hiring around 100 Cuban doctors annually to work in the public sector, as of 2010. [2]

Alongside universal health care the government also provides basic dental care. However, this does not include most orthodontic procedures, such as braces.[ citation needed ]

EBAIS

The Equipos Básicos de Atención Integral en Salud (EBAIS), or Comprehensive Basic Health Care Team, began operating in 1995, under control of the Social Security Fund. The program had been proposed two years earlier by a bipartisan committee of experts set up by the president to redress decreases in the quality of services that had occurred over the preceding decade. [6] The goal of the program is to ensure that all citizens have access to medical care, including rural residents. EBAIS employees are divided into teams of about five members, including one doctor. Team members visit people at their homes to vaccinate, offer medical advice, check vitals, and dispense medication. They also rectify any standing water situations they observe, which otherwise act as breeding grounds for mosquitoes and their associated diseases. [8] EBAIS designates certain residences as high-risk due to subs-standard housing and amenities or risky health conditions (e.g. teenage pregnancy). Members also address the health of patients' pets, such as ensuring that they are up to date on all necessary vaccinations. [11] There are nearly 1,000 teams, each overseeing the health of 3,500-4,000 individuals. [9]

After an original rejection, $9 million was later granted for the creation of EBAIS by the World Bank. The rest of the $50 million price tag was paid for by the Social Security Fund. [6]

The Costa Rican Social Security Fund is also charged with the administration of the public pension system.

Reformed Healthcare Litigation

The development of the current public and private healthcare system in Costa Rica and its movement towards a progressive system came about as a response to a growing constitutional health rights in Costa Rica. [12] [13] The Costa Rican Supreme Court, the Sala IV, released litigations for medications, treatments, and other health care issues. Criticism from inside the health system regarding "the court's jurisprudence elevated the right to health above financial considerations, and as a result posed a threat to the financial well-being of the state-run health care system." [14]

A 2014 study researched successful health rights litigation and showed that less than 70% of favorable rulings were for low-priority medications in Costa Rica, revealing an unfair access to medications. [14] To address these criticisms, the Sala IV partnered with the Cochrane Collaboration to integrate medical professional evaluations in its decision-making process for claims seeking access to medication. [14] Then a new study was conducted researching the court's reformed ruling process and whether it has changed in favor of the health rights conversation. It revealed that the probability of winning a medication lawsuit has increased drastically over time and that the percent of rulings granting experimental medications has declined while the percent granting high-priority medications increased. [14] Based on the results, in comparison to the court's pre-reform process, the reformed new process has led to some minor gains in fairness. [14]

Private

Costa Rica is a popular destination for medical tourism because of the beautiful surroundings, low costs, abundance of bilingual medical personnel, and medical reputation. [15] Over 40,000 Americans come to the country annually as medical tourists. [16] Private insurance plans are available through the government-owned insurance company(INS). Private plans include dental work, optometry, well-visit and annual check-ups. 80% of the costs are covered for prescription drugs, certain medical exams, sick visit and hospitalization. Surgeon and aesthetician costs are covered at full cost. Currently, private medical insurance costs about $60–$250/month per person, depending on gender, age, other factors. [7] Reasons for opting for private health care include shorter wait times and the ability to choose one's doctor. [17] Around 30% of the population utilizes private health services at least once a year, according to surveys. [9] Costa Rica has three internationally accredited private hospitals. [18] The four largest private hospitals in Costa Rica are CIMA in the suburbs of San Jose, Clínica Biblica in the center of San Jose, Clínica Católica and Hospital Clinica UNIBE in the suburbs of San Jose. [19] [20] Domestic private health insurance was not legalized until 2006. [6] International private insurance companies were not allowed to operate in the country until a Free Trade Agreement was signed with the United States in 2009. [9]

Pharmacy

Many drugs (like birth control pills, high cholesterol medication, migraine medicine, etc.) are available in Costa Rica without a prescription. Many common problems can be accurately diagnosed and treated by pharmacists. Also, most major pharmacies have a doctor on staff. Most Costa Ricans head to the pharmacy first and consult with the pharmacist or doctor on staff. Pharmacy staff will direct patients to the hospital for additional treatments or when the staff is unable to diagnose. [7]

Childbirth

Abortion in Costa Rica is restricted to situations that preserve the life or physical health of the mother. Abortions are illegal in cases of rape or incest, for social or economic reasons or when the unborn child suffers from medical problems or birth defects. [21]

Smoking

It is illegal to smoke in all public vehicles, public buildings and recreation areas such as parks, stadiums etc.

Related Research Articles

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

<span class="mw-page-title-main">Two-tier healthcare</span> Unequal access to higher quality healthcare

Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.

<span class="mw-page-title-main">Universidad de Ciencias Médicas</span>

The University of Medical Sciences is a private medical university in San José, Costa Rica. It is the largest and oldest private medical school in Costa Rica. Currently the main campus is located in the country's capital. The university offers degrees such as Doctor of Medicine, Doctor of Microbiology and Clinical Chemistry, Licentiate of Physiotherapy, Licentiate of Nutrition and Doctor of Pharmacy. UCIMED also offers master's degrees and medical specialties such as a master's degree in Health Management and Specialty in Gynecology and Obstetrics.

<span class="mw-page-title-main">Healthcare in the Netherlands</span>

Healthcare in the Netherlands is differentiated along three dimensions (1) level (2) physical versus mental and (3) short term versus long term care.

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

<span class="mw-page-title-main">Healthcare in Israel</span>

Healthcare in Israel is universal and participation in a medical insurance plan is compulsory. All Israeli residents are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations, known as Kupat Holim which are run as not-for-profit organizations and are prohibited by law from denying any Israeli resident membership. Israelis can increase their medical coverage and improve their options by purchasing private health insurance. In a survey of 48 countries in 2013, Israel's health system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2020, Israel's health system was ranked third most efficient in the world. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and ranked eighth in terms of life expectancy.

<span class="mw-page-title-main">Healthcare in Singapore</span>

Healthcare in Singapore is under the purview of the Ministry of Health of the Government of Singapore. It mainly consists of a government-run publicly funded universal healthcare system as well as a significant private healthcare sector. Financing of healthcare costs is done through a mixture of direct government subsidies, compulsory comprehensive savings, national healthcare insurance, and cost-sharing.

<span class="mw-page-title-main">Healthcare in Germany</span>

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

<span class="mw-page-title-main">Costa Rican Social Security Fund</span>

The Costa Rican Social Security Fund is in charge of most of the nation's public health sector. Its role in public health is key in Costa Rica, playing an important part in the state's national health policy making.

The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population. Authority and service delivery are divided between the national Department of Health, provincial health departments, and municipal health departments.

Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).

<span class="mw-page-title-main">Healthcare in Belgium</span>

Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

Abortion in Costa Rica is severely restricted by criminal law. Currently, abortions are allowed in Costa Rica only in order to preserve the life or physical health of the woman. Abortions are illegal in almost all cases, including when the pregnancy is a result of rape or incest and when the foetus suffers from medical problems or birth defects. Both social and economic factors have led to this legal status. It remains unclear whether abortions are legal to preserve the mental health of the woman, though the 2013 United Nations abortion report says Costa Rica does allow abortions concerning the mental health of a woman.

Examples of health care systems of the world, sorted by continent, are as follows.

<span class="mw-page-title-main">Healthcare in India</span>

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It also ranks 77th on the list of countries by total health expenditure per capita.

Guido Miranda Gutiérrez was a Costa Rican civil servant and medical doctor. Miranda is credited with spearheading the effort to push the Costa Rican Department of Social Insurance from the capital of San José into smaller municipalities and rural regions.

<span class="mw-page-title-main">Healthcare in Slovakia</span>

Healthcare in Slovakia has features of the Bismarck, the Beveridge and the National Health Insurance systems. It has public health system paid largely from taxation. The cost of national health insurance is shared between the employees and the employers. The part of these taxes are paid by the employees as a deduction from theirs wages and the remaining part of these taxes is paid as compulsory contribution by employers. Sole traders pay the full amount of these taxes. 

References

  1. ↑ Connolly, Greg (December 8, 2002). "Costa Rican Health Care: A Maturing Comprehensive System". Archived from the original on September 23, 2016. Retrieved November 12, 2009.
  2. 1 2 3 Warf, Barney (2010). "Do You Know the Way to San José? Medical Tourism in Costa Rica". Journal of Latin American Geography. 9 (1): 51–66. doi:10.1353/lag.0.0074. S2CID   145473002.
  3. ↑ "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-03-17.
  4. 1 2 3 4 "Costa Rica - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-17.
  5. ↑ Morgan, Lynn M. (Spring 1987). "Health without Wealth? Costa Rica's Health System under Economic Crisis". Journal of Public Health Policy. 8 (1): 86–105. doi:10.2307/3342487. JSTOR   3342487. PMID   3108317. S2CID   29785875.
  6. 1 2 3 4 5 6 7 McGuire, James W. (2010). "Costa Rica: A Healthy Democracy". Wealth, Health, and Democracy in East Asia and Latin America . New York: Cambridge University Press. pp.  65–93. ISBN   978-0-521-13934-2.
  7. 1 2 3 "Costa Rica Health Care". CostaRica.com. Retrieved 1 May 2012.
  8. 1 2 Buettner, Dan. "The World's Happiest Places." National Geographic, Nov. 2017, p. 45.
  9. 1 2 3 4 5 6 7 Cercone, James, Etoile Pinder, Jose Pacheco Jimenez, and Rodrigo Bricena. "Impact of Health Insurance on Access, Use, and Health Status in Costa Rica." The Impact of Health Insurance in Low-and Middle-Income Countries, edited by Maria-Luisa Escobar, Charles C. Griffin, and R. Paul Shaw, Brookings Institution Press, Washington, D.C., 2010, pp. 89-105.
  10. ↑ "CCSS | Caja Costarricense de Seguro Social: Funciones". Archived from the original on 25 December 2010.
  11. ↑ "Students travel to Costa Rica to study health care system | Penn State University" . Retrieved 2017-12-06.
  12. ↑ Pesec, Madeline.“Primary Health Care That Works: The Costa Rican Experience.” Health Affairs, vol. 36, no. 3, 2017, pp. 531–538., doi:10.1377/hlthaff.2016.1319.
  13. ↑ "Do You Know the Way to San Jose? Medical Tourism in Costa Rica". ResearchGate. Retrieved 2020-05-08.
  14. 1 2 3 4 5 LOAIZA, OLMAN RODRÍGUEZ; MORALES, SIGRID; NORHEIM, OLE FRITHJOF; WILSON, BRUCE M. (2018). "Revisiting Health Rights Litigation and Access to Medications in Costa Rica: Preliminary Evidence from the Cochrane Collaboration Reform". Health and Human Rights. 20 (1): 79–91. ISSN   1079-0969. JSTOR   90023055. PMC   6039739 . PMID   30008554.
  15. ↑ Walecia Kinrad (March 20, 2009). "Going Abroad to Find Affordable Health Care". New York Times. Retrieved 2010-03-28.
  16. ↑ Canelo, Abelardo (2017-12-05). "Costa Rica: A Country Loved by Expats | The Costa Rica News". The Costa Rica News. Retrieved 2017-12-06.
  17. ↑ Barrera, Gilberto (2017-12-04). "Costa Rica's Curious Facts | The Costa Rica News". The Costa Rica News. Retrieved 2017-12-06.
  18. ↑ Chrissie Long (March 11, 2010). "Why Rush Limbaugh would go to Costa Rica if Obama's healthcare plan passes". Christian Science Monitor. Retrieved 2010-03-28.
  19. ↑ "Health Care in Costa Rica". Century 21. Retrieved 4 May 2012.
  20. ↑ "Health Care in Costa Rica Hospital Clínica UNIBE (Universidad de Iberoamerica)". Plastic Surgery Forums Costa Rica. Archived from the original on 2 April 2016. Retrieved 18 May 2012.
  21. ↑ "Summary of Abortion Laws Around the World". Archived from the original on 2019-02-12. Retrieved 2012-05-02.
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