Costa Rica, a small developing country of 4.6 million people, in Central America, surprised many people by having a health care ranking by the World Health Organization higher than the United States. The life expectancy of people in Costa Rica is higher than the U.S. and the infant mortality rate is approximately the same. What is incredible is they are spending $6,000 less per capita than the U.S. and they are covering all of the people.
The Costa Rican Social Security System was started in 1941, by President Rafael Angel Calderón Guardia, a Costa Rican physician, who was educated in Europe. He modeled the program after the one in Chile.
As in the U.S. now, the Costa Rica national health care system was strongly opposed by doctors, employers and pharmacies at the time. There were concerns, just like in the US that it would eliminate private medicine and related businesses. However, the government of Costa Rica had the courage to move ahead and coverage was gradually expanded. Each step was met with complaints that it would eliminate private medicine.
The Caja, the name of the Costa Rican national health care program, is funded for the most part by employers who pay 9.25 percent into the social security system and employees who pay 5.5 percent. The government provides only for the 17 percent of people that live below the poverty line.
Costa Rica also offers a private option, which primarily serves the upper middle and upper class. The cost is approximately $800. a year depending on age and medical condition. This allows them to avoid the wait time associated with the Caja. They have found, in order to compete with the public system, that private practices are keeping their rates low.
Is the Caja perfect? Absolutely not and they are working to make it better. There are wait times for non-emergency care. An example is a man who has waited 35 days for hip replacement surgery. The country is also working to expand services in rural communities making it unnecessary to come to San Jose, the capital, for treatment. However with these problems, the Costa Rican people are justifiably proud of their health care system which provides high quality, the latest technology and doctors who divide their time between private and public sectors of health care.
Chrissie Long of the Tico Times, the leading English-language newspaper is doing an excellent in-depth analysis of Caja. In her interviews she found that while people interviewed in Costa Rica voiced concerns about delays, they would not trade their system for the one in the U.S. A doctor she interviewed, Danilo González stated, “Anyone – anyone can receive care in Costa Rica, and they’ll receive the best care available in the country. In the United States (what happens) if you don’t have insurance and can’t pay? Out the door. You are left to die in the streets. “
Rosa Climent, the director of the day to day operations of the Costa Rica Social Security System stated the biggest obstacle to the U.S implementing national health care was the lack of solidarity. Referring to the U.S., she stated, “They don’t have the same commitment to solidarity. We have a culture of solidarity in our country, in which people with more economic means, take care of those with less.