Health care in Costa Rica: An up-close examination

For the CDTJanuary 11, 2014 

While the Northeast was experiencing its first big snowstorm of the year, a group of students spent a week traveling through the lush, green mountains of Costa Rica.

Although most Americans are drawn to Costa Rica for its diverse rain forests, stunning beaches and world-class coffee, these students traveled to study the various facets of the country’s health system.

The trip was offered as an embedded short-term study abroad opportunity through Penn State’s health policy and administration department, as a supplemental component of its Comparative Health Systems class. For the second year in a row, eight students and their instructor traveled through urban and rural areas of Costa Rica to take a firsthand look at how that nation’s universal health system works.

Under the universal system, every Costa Rican citizen has health care coverage and can use the public system. Funded by a 9 percent employee income tax and a variable employer contribution, the health system provides care to all, regardless of pre-existing conditions or the extent of the treatment needed.

There are no bills sent to patients, and prescription medications are free. With an even greater physician shortage than the U.S., the Costa Rican health system’s main flaw is its lines for elective procedures. However, a citizen may purchase private insurance and use the private clinics and hospitals to avoid the lines altogether.

While meeting with Vice Minister of Health Dr. Sisy Castillo Ramirez, students learned that it has been 64 years since Costa Rica disbanded and eliminated its military. Since then, the entire government budget spent on defense has been reallocated to health and public services.

Costa Rica now has potable water and sanitation facility access in 95 percent of the country. It was surprising to hear how proud Costa Ricans are that they do not have an army or any enemies.

“The only reason Costa Rica would ever bring back its army would be if someone threatened our health system,” Ramirez said.

While touring the various hospitals and clinics, it was not difficult to notice the obvious differences between Costa Rican facilities and those in the U.S. For example, most buildings featured an open-air exterior, in which the walls did not fully enclose the facilities.

This allowed for fresh air to flow through the hallways, providing a calming atmosphere for patients and their families. One regional hospital featured a butterfly garden that was not only attractive, but also designed to promote good mental health.

However, one would also notice the needs of the facilities as well.

The buildings themselves were not necessarily visually appealing.

Walls needed new paint, the furniture was often old and there was an absence of that sterile shine that we see in American hospitals.

Despite the need for some remodeling and upgrading, Costa Rica’s health outcomes are well above their neighboring Central American countries and are right up there with our statistics in the U.S.

Doctors and officials at the Ministry of Health were very proud of their low infant mortality rate of 8.6 deaths per 1,000 live births. Though higher than in the U.S., the rate could be even lower if abortion was legalized in Costa Rica. Instead, even when there is evidence of abnormal pregnancy or congenital diseases and disorders, the law prohibits abortion.

The 2013 data from the World Health Rankings lists Costa Rica’s life expectancy at birth to be 79.1 years, which is longer than the 78.6 years in the U.S. Hospital-acquired infection rates match what we see in the U.S. and continue to follow a downward trend.

Credit for the country’s remarkable health outcomes must partially be given to ATAPs, who are health workers trained in basic primary care and social work. ATAPs essentially do house calls for the people living in remote, rural areas where the nearest clinic is a considerable distance away from their homes. During visits, ATAPs administer vaccines, monitor vitals, discuss chronic disease treatments and survey the homes for safety, utility access, and any possible domestic or child abuse.

Touring Costa Rica and seeing its health system in action was an extremely valuable experience for these students. It provided a new perspective on health care delivery, complemented the comparative health systems class and gave them knowledge to make informed opinions about the future of health care in the U.S.

Chris Gilbert is a Penn State student.

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