A breath of fresh air

In Costa Rica, coffee is always fresh, passers-by smile and wave to visitors, and the colorful views of the mountains seem to come straight from a storybook. But what was most refreshing was the time that I spent learning about Costa Rican hospitals and care facilities — most of which are built without full exterior walls, allowing fresh air and a calm breeze to reach those inside.

Nine students and two professors toured the country for a week to experience and evaluate its health care system first-hand. It was the first of its kind. The trip was sponsored by Penn State’s health policy and administration undergraduate department as an extension of the current comparative health systems course. The course helps students compare and analyze differences in health systems across varying levels of developed countries.

Penn State instructor and trip coordinator Celeste Newcomb said she was excited to offer the opportunity to her students.

“Shadowing community health workers in rural Costa Rica, seeing public health in action and talking with health administrators and providers in a variety of health care settings allows students the chance to broaden their horizons as well as their understanding of Global Health issues,” she said.

It was easy to see how different it is from our service here in the United States when experiencing the Costa Rican health care system up close. At the public hospitals and clinics that we visited, we saw the stark needs of the facilities — flaking paint on the walls, outdated furniture, lack of strict privacy regulations, and limited use of electronic medical records.

But, despite the outward differences, this developing country has impressive health outcomes that are comparable to those in the United States.

The CIA World Factbook reports the 2012 life expectancy at birth in Costa Rica to be 77.89 years, which isn’t far behind the 2012 rate in the United States of 78.49 years. Furthermore, Costa Rica sustains a very low infant mortality rate for a developing country: 9.2 deaths for every 1,000 babies born. This number is only slightly higher than the current infant mortality rate in the United States of 6 out of 1,000.

Additionally, Costa Rica also spends a much smaller percent of GDP and has fewer physicians per population than the United States.

Looking beyond outward appearances and statistics, the roots of the Costa Rican health care system are much different than our own. The country operates under a universal system where health care funds are handled via a third-party (non-government and non-health delivery) organization called “La Caja,” which translates to “The Cashier.”

All funds are paid through direct taxes on payroll, and taxes are paid out by both the employee and the employer. Under this universal system, no person can be refused health care or forced to pay out of pocket. Citizens may purchase private insurance and use private hospitals if they are able, which is a growing trend within the past five years.

We spoke with patients, providers and administrators who all felt it was essential that everyone in Costa Rica have access to health care.

Although there are many differences between the Costa Rican health care system and ours, one of the most influential differences can be found in Costa Rica’s empowering emphasis on preventative care and promotion. This ideal is embodied in the unique health care workers known as ATAPs, who are trained with basic nursing and social work skills.

Part of our time in Costa Rica was spent accompanying the ATAPs on their “rounds” — people in rural communities are visited at their homes at least once per year by an ATAP. While there, the ATAP provides any routine vaccinations, dietary tips or basic medicationsmembers of the family might need.

In addition to checking on basic health, the ATAPs also check each home for running water, electricity, and good treatment of any pets. If there are any social counseling needs, the ATAP will visit up to six times per year to accommodate these families.

Visiting the ATAPs, hospitals and clinics, and learning about the Costa Rican healthcare system was an amazing experience for myself and all of the students involved. The trip gave us the opportunity to see community care on a whole new level, and opened our eyes to the vast array of approaches to improving overall health.