Costa Rica: A study in universal health care

December 5, 2013 

Entry 10: Reflections on what we did in San Jose —Yordi Ashagre

As we visited three different facilities today in San Jose, I learned many things about the Costa Rica healthcare system as well as the culture in general. The one thing I observed about the healthcare professionals and the system in general is that they are more focused on the population and their health rather than the money which seems to be the main concern in the United States. I was able to pick up on that from their speeches.

For example, Dr. Hernandez from the children hospital was saying how children are citizen of the world and how they don’t have nationalities therefore every one of them despite which country or region they’re from should get the proper treatment. Also, in the meeting with the vice minister of health, they talked about how their system is going to fail because the government is taking care of/paying for a lot of things in their healthcare system, and I like how she responded by saying that they will stay positive and fight to have this system continue despite money loss because they are not putting their benefits as far as income first but rather the patients that are able to receive care for free. This was different from what we’re use to in the U.S. because most everything there is about money and not patients. In conclusion, the first day has been very informative as to how the healthcare system operates, and in learning what their values are.

Entry 9: Health Systems Standout’s – Steve Jacobs

Today we ended our time in Las Juntas by donating both a wheelchair and a walker to some of the local families that were in need of the supplies. They were all extremely grateful for our efforts and it was nice to see their gratitude for our donations.

Throughout the past five days, I have learned a great deal about the Costa Rican healthcare system, which has made me think about some improvements that could be made to the American healthcare system based off Costa Rica.

First, one of the most noticeable characteristics of the Costa Rican system is that every single citizen gets some sort of healthcare no matter their socioeconomic status. When we followed the ATAPs yesterday we visited some of the poorest regions of Costa Rica, but the citizens were still being treated for a variety of illnesses and seemed to be in decent health status.

In America we are not as forceful and do not ensure that everybody is seen, so some of the poorer citizens never receive any medical attention. Even though there are programs set in place such as Medicaid, many people do not have the means or resources to seek out care for themselves. I feel that if we had a system set in place for people to make house calls to the citizens in the United States than we would not have as big of an issue with a large portion of the population not receiving healthcare.

A second area that I feel we could take from the Costa Rican healthcare system is their open-air hospitals. All of the facilities that we have visited so fare have been very open with a lot of fresh air constantly circulating throughout them. This almost makes you forget that you are in a hospital, and can really help to take your mind off the illnesses. In America the hospitals are often very confined and enclosed, so you can feel the sick are constantly sitting in the hospital. This makes the hospitals give off a very sick vibe and does not promote a healthy setting for the patients to be in. I feel that if we were to construct some of our hospitals to allow more fresh air to flow through then patients would have better mental health and could potentially heal quicker.

Entry 8: Costa Ricans live longer than Americans — Yordi Ashagre

We have seen many differences between the U.S. healthcare system and the Costa Rican healthcare system within these five days. One of it being that Costa Rica has a universal healthcare system and the U.S. does not. Another difference is the Costa Rica healthcare system emphasizes more on primary care or basic house to house care than the U.S. This helps all the populations of Costa Rica get the basic care they need and prevent potential diseases because they get care often.

This system has also increased the life expectancy of the population to an average of 79 years which is higher than the U.S., which is an average of 78. With the recent implementation of Obama Care, the U.S. is attempting to have “universal” healthcare system as well. However, the cost of healthcare is still high for a lot of people, which means people will not seek care unless they have to. It’s easy to say we should have ATAPs visiting homes in the U.S. and provide care for free for everyone; however, there are demographic, social, financial, political and other limitations that prevent the Costa Rican healthcare system to work in the U.S.

Entry 7: Geography’s effect on healthcare, economy — Tianyu Sun

One thing that I’ve really enjoyed since landing in Costa Rica has been the mountain ranges. In addition to making the country extremely scenic, they have an effect on the climate, which as a result impacts the Costa Rican healthcare and economy.

During my flight into San Jose, I noticed a lot of houses were set up on the sides of steep mountainsides. It proved to be an important factor when it comes to healthcare access. Today, we visited a family living near Las Juntas with a walker to help provide the bedridden husband with some walking aid. In order to get to the house we traveled 20 minutes on a bumpy gravel road up the steep mountain. It is easy to see how it might be tough for people living in these conditions especially when they’re also dealing with economic obstacles. It turns out this family moved from a different area to this place in order be in range of the ambulance in case of emergency. Furthermore, the mountain range makes it difficult for many other Costa Ricans to access healthcare. For instance, a person might live closer to one regional hospital but are forced to go to one farther away because it might be impossible for them to get to the one close to their home through the mountain.

The mountains also establish a foundation for coffee plantations, coffee being one of the major economic contributors for the country. These coffee plants grow healthily on the sides of the mountains, we were able to see the coffee making process from the planting of the seed to roasting the beans to make the delicious coffee that Costa Rica is famous for.

The mountains also had economic influence to the country with the presence of gold. Although we learned that gold mining haven’t been done in well over a century and had negative effects to the environment, it was prevalent in the 1800s. We went to an old gold mine for a hike, great views and saw the machines and tools that were used when the mine was functioning. Today was a good day; despite the long hours on the road we had some good food and especially gorgeous views on the mountains.

Entry 6: Making a small budget work — Jayme McKenzie

Upon examining Costa Rica’s health care system, many unique processes and styles of cares have been brought to my attention. A few things have stood out to me, such as the hand-written point system that we saw the ATAPS use during the home visits, the stretching of resourses, and the overall simplicity of care. Of these factors I believe the stretching of resources contributes the most to the overall health of the Costa Ricans. Their overall life expectancy is higher for both males and females then the United States. ( http://www.worldlifeexpectancy.com/global-health-comparison-index-costa-rica)

As Dr. Hernadez said, they have a small budget, but they make it work. As I have said before, Costa Ricans put their money toward the most important aspects of care. Not only does spreading resources eliminate unnecessary material items but it also prevents profuse medical testing, which may actually be detrimental to patient’s health. If this system were applied in the United States it would save us money, and prevent unnecessary testing.

Entry 5: A beautiful morning — Celeste George Newcombe

It’s a beautiful morning here in Las Juntas. After breakfast we will head back to the clinic to meet with the director. Afterward, we will head with out with the ATAPs (Javier Angel Mojica and Jairo Martinez) again for a special project. We were fortunate to have brought a wheelchair and walker along with us, donated by Mount Nittany Medical Center, and we will be giving these away to local community members. I know all of us are looking forward to this event!

This afternoon we will be traveling to Monteverde.

Entry 4: Dentistry — Steve Jacobs

Today we visited Las Juantas, Costa Rica, so that we could get a better understanding of the Costa Rican healthcare system in some of the less populated areas. While we were there we stopped at the Las Juntas free clinic where they deliver a wide variety of healthcare services to the indigenous population. We were fortunate enough to take a tour of the laboratory where we learned about how they take the different types of tests that they perform on the patients.

We met with the microbiologist, Fabiola, and she explained to us how she studies the different antibiotics and tests for them using the equipment. We also met with the dentist who was filling in for one of the main dentists at the public clinic. He explained to us about the difference in protocols between the public and the private dentists offices. In the public offices there are strict rules where a patient can only stay for 15 minutes at a time, so they must keep coming back to have one procedure over the course of many different visits.

On the other hand in the private offices they are free to see the patients for as long as they want and they can perform lengthy procedure in one sitting. We also had the opportunity to shadow one of the ATAPs, Jairo, on his house calls to the population. He explained to us how he visits about six to eight houses per day, each being ranked on a points system based on their risk factors. The more points that a family receives during their evaluation means that their there house is in worse conditions and they are then entitled to more frequent visits by the ATAPs.

We also got to watch him administer different vaccinations to people who were due for them and observed how he had lengthy conversations with the mothers of the family to get a better idea of their lifestyle. It was extremely eye opening to be able to see how even in the most impoverished areas of the country people still are given healthcare and nobody is left completely one their own. This day was a great change of pace from the very urban hospitals that we observed in San Jose, and is something that will stick with me for a very long time.

Entry 3: Care, no matter what — Steve Jacobs

Today in San Jose, Costa Rica, we visited different facilities that gave me a little more insight into the Costa Rican healthcare system. First we met with Dr. Hernandez at the children’s hospital. He first told us about their policy to never deny any children care if they are in need no matter what their nationality, even if they are not Costa Rican. He made an emphasis of saying that their ideology that children do not have a nationality and that they are children of the world, so there is no possible way that they should ever be denied care of any kind.

I feel that this is a great philosophy and is something that other countries could take a lesson from, because children of all races and ethnicities should have access to good healthcare. He then explained the demographics of the hospital, which were astounding to learn. He talked about how the children’s hospital took care of 30 percent of all of the Costa Rican population even though they only had 195 staffed physicians, while some of the smaller hospitals had up too 400 physicians on staff. Another eye-opening statistic that I took away was that they screen 98 percent of all infants in Costa Rica for a variety of diseases at birth, and that all of the lab work was performed at that children’s hospital.

He then explained that if a disease was found that they would make a house call to deliver care to the newborn child. We then met with the staff of the Costa Rican Ministry of Health. There Dr. Ortiz explained their philosophy that delivering care is not the only objective, but that they must take care of their environment too in order to have a truly healthy country. I really liked this theory, because in America we tend to take advantage of our land and resources, which jeopardizes our entire ecology. Overall I learned more information on our first full day at Costa Rica than I could fit into this journal, but those were some of the most staggering pieces of information that I learned from our first day of adventures.

Entry 2: Social Security — Tian Sun

After a very interesting night of battling bed bugs and finding a new place to sleep, everyone was extremely tired. However, I really looked forward to this day because I felt this would be the time where we get to see where the real difference is made. I was impressed with the Ministry of Health and the Hospitals, but I think the ideas and facilities in the United States are much more advanced. To me the job that the ATAPS do at each EVAIS or local clinics is what sets Costa Rica apart from its neighboring countries and makes it a healthcare stalwart.

The ATAP (Jairo) we followed was very patient with our questions and genuinely wanted us to learn about his job. But before I talk about the job that he does, I just want to comment on the subpar living standards this particular village seems to be content with. The walls and ceilings were made of simply made of metal; further the conditions inside were at times much worse than outside. This was one of the things that Jairo looked for when he were assign conditions of risk. Having below-average economic resources often times results in the families not on social security. That in turn leads to Jairo being their only source of healthcare since they would not be accepted at hospitals and clinics without social security (even if Jairo refers them). Being that this was prevalent in the neighborhood, this lead to similar problems in each household.

I was really surprised to learn that everything Jairo did was for free, even for those not under social security. I think it is this mentality that really differs from the United States. One of the most important responsibilities that ATAPS have is the prevention of disease. He goes to over 2,000 households each year, and in many cases (especially the neighborhood we visited today) up to three times each year. Compared to the United States, where it seems that people don’t go to the doctor or get seen by a health professional until they get sick. The doctors in the US have to “fix” the problem they face, whereas here in Costa Rica, doctors and health professionals take on the added responsibility of overseeing and carrying out disease prevention. I truly believe if the mentality of the U.S. health system could shift slightly more toward the Costa Rican way of thinking, then we’d see better health outcomes and results.

Entry 1: Between the gold — Lourdes Ponte

Since yesterday we have been traveling from hospital to hospital. Yesterday, we visited a Level 1 hospital, San Rafael de la Alajuela, where they had advanced technology and a good infrastructure. The rooms were spacious and open where bright colors would create a relaxed and warmed atmosphere. This hospital cares for their patient’s whole well-being; they even had a butterfly farm.

I feel like health providers don’t only care about the biological aspect of the illness, but they also care for the mental and spiritual health of their patients. This emphasis on the well-being of the patient is not only seen at big hospitals. When we arrived to the clinic in Las Juntas, the infrastructure was modest but they still seem to pay great attention to well-being of person. These clinics have the ATAPS (technicians in Primary Attention) who travel house to house checking blood pressure, diabetes, give needed vaccines and educate about health risk factors to all the members of household. I feel like a program similar as ATAPS program could be applied to the U.S rural populations who either don’t have access to care or they are reluctant to get care because of transportation difficulties and/or not interest.

People from Costa Rica have shown to genuinely care about their country’s well-being. Sometimes in the US, we care more concerned about the numbers and all the formalities which are somewhat necessary but most of the times only complicate the system even more. I feel like simplicity and efficiency contributes to the greatness of this system and that’s what we need in other places.

A group of Penn State students and their instructor in the Comparative Health Systems class this fall semester traveled to Costa Rica this week to study the country’s universal health system in both urban and rural areas. During the visit, the group is touring hospitals and clinics and working alongside health professionals. Check back each day this week for more entries and observations from the class.

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