Emily Crigger
Health Care in Costa Rica
In a 2010 position paper presented to the World Health Organization, Dr.
Mario del Rocio Saenz, the former Costa Rican Minister of Healthcare,
collaborated with two assistants to present a status update on Costa Rica’s
healthcare system.
It is interesting to note that universal
healthcare is never mentioned as a right in the Costa Rican Constitution. However, Costa Rica’s establishment of Caja
Costarricense de Seguro Social,
more commonly known as CCSS or the Caja, clearly references that “the right to
Health is a fundamental one” and “all
residents have the right to healthcare provisions and the obligation to contribute with the
preservation of health and to maintain the health of his/her family and community.” Additionally, the Caja establishes that “the
health of the population is a public interest guaranteed by the State.” In essence, the government of Costa Rica
mandates universal healthcare for its citizens.
Costa Rica is one of the few Latin
American countries offering complete and universal health care coverage in both
financial and geographical terms. The health care system is sustained by
workers, employers, and the government and 87 percent of the population is
covered. The position paper describes six separate categories of beneficiaries
set up by the Caja: 1) direct or employer-employee relationship, 2) self-insured
(voluntary self- insured, 3) pensioner, 4) family insured (relatives of direct
beneficiaries, pensioners, or self-insured beneficiaries), 5) insured by the State,
and
6) non-insured (those with the
capacity to pay but who choose not to but are still given free emergency room
access).
For health care delivery purposes, the country is divided up into 105
Health Areas covering 30,000 to 60,000 residents. These health areas are further subdivided up
into small population sectors of 4 residents. There are three distinct levels
of healthcare offered in Costa Rica referred to as first, second, and third
level of attention. Across Costa Rica,
there are 947 Equipos Básicos de Atención Integral de Salud or EBAIS (Basic
Provision Units of Integrated Healthcare) which provide all care at the first
level of attention. Care given at the second level of attention is provided in
a network of
11 large clinics, 13 small
hospitals, and 7 regional hospitals. ER services, diagnosis support,
specialized outpatient consultation, and simple surgical treatments are all
given as part of healthcare at the second level. The care given at the third level of
attention is provided at 4 specialized and 3 national concentration hospitals,
and is the most technologically complex of the three levels of care.
As stated already, Costa Rica’s
healthcare system is funded by contributions from employers, employees, and the
government. The government’s share of funding has shown a steady decrease. The government’s share in 1993 was 18.3%, in
1999 it was 9.2%, and in 2001 was 7.3%.
In 2012, the governments share ranged from 0.25% to 0.50 %. The non-insured’s healthcare access, which
is primarily limited to emergency room care, is funded by the Costa Rican
government through private and corporate donations to the Fund for Social
Development and Family Welfare, and taxes on lottery tickets, alcohol, sales
and tobacco sales.
Costa Rican healthcare is “allocated” but in America we would refer to it as
“rationed”. The demographics of those
living in each Health Area are analyzed, and then the necessary resources are
moved to that area by Caja to provide healthcare specific to the needs of that
area. Medications are also allocated to the different Health Areas of the
country, and there can be a delay in receiving rarely-used medications for unusual
diseases and illnesses. Costa Rica’s
healthcare system has remained significantly stable, experiencing a minor
decrease in funding during the global economic challenges from 2007 – 2009.
This was enough, however, for the Costa Rican government to pay much more
attention to “global economic variables” such as production and employment, as
well as a nationwide aging population and a growing unemployment rate.
Costa Rica
recognized early on that it wanted to be a nation whose citizens had full
access to health care, and where employers worked together with employees and
the state to make this happen. The
healthcare system there has evolved and adapted to become one where any citizen
who wants quality healthcare has it, and those who do not still may access the
system for emergency care.
http://www.who.int/healthsystems/topics/financing/healthreport/CostaRicaNo11.pdf
March 17, 2013
5:50 PM
No comments:
Post a Comment