Costa Rica Health Care System Essay

In terms of healthcare, you could call Costa Rica the little country that could. Over the past seventy years the government has enacted reforms that have changed the face of both the system and health of a country. The Costa Rican health system is dedicated to providing equitable access to citizens, while protecting them from financial risk. The improvement this middle-income country has made rivals that of higher-income countries. However, while this system is fundamentally efficient and effective, it is not without problems.
Population Health
Throughout the last seventy years Costa Rica’s healthcare system has been going through a transformation. As the nation has taken steps to improve the health care system, the health of the country’s
population has also drastically improved. In1950 the total population of Costa Rica was approximately one million and the life expectancy of these citizens was 56 years (Vargas & Muiser, 2013). The fertility rate for women at that time was 6.7 (Vargas & Muiser, 2013). By the twentieth century the population reached close to four million citizens, and the life expectancy of both male and females had risen to seventy-eight years (Vargas & Muiser, 2013). This life expectancy rate placed Costa Rica second in the Americas, behind Canada (Unger, et al., 2008). The fertility rate of women also dropped to 2.4 (Vargas & Muiser, 2013). Over the last few decades Costa Rican’s life expectancy at birth has gained 22 years, that is a marked improvement. During this transformation the population has also seen a drop in both the perinatal and infant mortality rates. The infant mortality rate boasts a seven-time reduction rate in the last 30 years and currently sits at nine deaths for every 1000 births (Unger, De Paeipe, Buitron, Soors, 2008). The perinatal mortality rate has dropped to 5.4 deaths per 1000 births, down from 120 per 1000 births in 1972 (Unger, et al., 2008). Costa Rica has also made improvements in several social determinants of health. The country boasts a very low illiteracy rate of 4.8%, 7.9 % in rural areas (Costa Rica, 2013). Another Millennium Development Goal achieved by Costa Rica is that by 2009, 99% of the country’s population had access to clean water (Costa Rica, 2013).
Health System Development Costa Rica’s health system sets the nation apart from the country’s neighbors in Latin America.
Throughout the past few decades the country has transformed its health care system, which aims to offer equitable access, coverage, and services. These efforts have been successful and Cost Rica’s life expectancy is ranked second in the Americas (Unger, et. al., 2008). The nation’s health care system was even ranked 36th out of 191 countries in 2011 for the best health system performance by the World Health Organization (WHO) (Bertodano, 2003). The Costa Rican health system of today began its transition in the 1940s. It was during that time that the nation developed the social security fund known as Costa Rican Security Services (CCSS) to provide social and financial protection to the nation’s workers (Vargas & Musier, 2013). In 1947 the nation dismantled its military, freeing up additional funding to spend on education and health care services (Bertadano, 2003). According to Vargas and Musier this transition did not come without some opposition. The medical providers at the time were opposed to a system overhaul by the State and formed a labor union to strengthen their voice (2013). Recognizing the need for support, or at least participation, from the medical providers the government negotiated a compromise. The doctors in Costa Rica would be employed by CCSS, but would be allowed to maintain their private practices (Vargas & Muiser,
2013). Throughout the 1960s and 1970s the healthcare system continued to expand. With the passage of the Social Security Universalization Act in 1961 it was determined that CCSS coverage would expand over the next ten years (Vargas & Muiser, 2013). In 1973 the Hospital Transfer Act gave control of all public hospitals to the CCSS (Vargas & Muiser, 2013). This act was meant to increase universalization, recognizing that a hospital network was needed in order for the system to be able to achieve equitable acceptance and treatment for patients(Vargas & Musier, 2013). It was also a political and economical decision to transfer existing hospitals to the CCSS in lieu of building new facilities (Vargs & Musier, 2013). This decision saved the Costa Rican government from having to build new hospitals, which is not feasible for a publicly funded health care system. During the primary care reform in the 1990s the CCSS developed Basic Comprehensive Health Care teams (EBAIS) in an effort to increase access to preventive care for citizens (Unger, et al., 2008). These facilities offer citizens a combination of family and community care which is focused on prevention and primary care (Unger, et al., 2008). The public clinics or EBAIS are outpatient facilities and are located throughout the country one per every 5000 patients (Unger, et al., 2008). As it stands today the Costa Rican health care system is equipped with 29 hospitals and 240 public clinics with 5,924 beds total throughout the country (Clark, 2002). Secondary care is offered through ten major clinics, thirteen peripheral hospitals, and seven regional hospitals (Costa Rica, 2013). Secondary care encompasses oral care, microbiology services, inpatient care, and basic surgeries (Costa Rica, 2013). Care on the tertiary level includes specialized care in areas such as women’s health, pediatrics, and rehabilitation (Costa Rica, 2013).
These services are offered in three national general hospitals, and five national specialty hospitals (Costa Rica, 2013).
The CCSS is financed through a combination of contributions from employers, workers, and the State. This financing is most reliant on the contributions from employer/employee contributions, which is responsible for 90% of the finances (Saenz, Bermudez, Acosta, 2010). The percentage the employee pays in is based on their income level (Saenz, Bermudez, Acosta, 2010). Formal workers are autonomously enrolled and employees typically pay around 5% of their income, with employers paying 9.25% and the state paying less than 10% (Clark, 2002).
The Costa Rican health care system consists of several different types of beneficiaries (Saenz, Bermudez, Acosta, 2010). One type of beneficiary is known as a direct beneficiary. Direct beneficiaries are those formal workers who are required to participate in the CCSS (Saenz, Bermudez, Acosta,
2010).
The second type of participant is the voluntary participant, who includes self-insured or informal workers, such as agricultural employees (Saenz, Bermudez, Acosta, 2010). Self-employed citizens have the ability to chose to join the CCSS voluntarily. If they decide to join they are required to pay 5.7-13.75% of their income, depending on the amount of their annual income (Clark, 2002).