Costa Rican Health System Overview
Health System Rankings
Health System Outcomes
Coverage and Costs for Consumers
Health System Expenditures
Health System Financing
Health System Physical Resources and Utilization
People With Disabilities
Social Determinants & Health Equity
Health System History
Health System Challenges
“Health insurance contributions to the CCSS [Costa Rican Social Security Institute] are tripartite and represent 15% of formal sector workers’ salaries for the period 2015-19. All workers earning income from an economic activity (salaried and independent workers) must contribute with the exception of the poor and the vulnerable. Those without an economic activity can affiliate on a voluntary basis. However, once an individual is enrolled in this voluntary scheme, he or she can no longer withdraw from the CCSS and contributions become mandatory. Contribution rates for independent and voluntary affiliates are determined on the basis of their reported income and a reference income established by the CCSS, as described in Chapter 1.
“Independent workers and voluntary affiliates already represent almost a fourth of all contributing affiliates adding complexity to the control of contributions and making the CCSS more vulnerable to evasion and elusion. This group is more difficult to enroll and to control and is, therefore, at a higher risk of either contributing less than stipulated (elusion) or not or not making any contributions at all (evasion). It is likely that many independent workers affiliated with the CCSS under-report their income but it has been a substantial challenge for the national authorities to identify this group and to calculate the extent of evasion and elusion. This is another indication that one of the key challenges of the CCSS is its still insufficient information to manage some of its key drivers determining its financial sustainability. Another challenge for the financial sustainability of the CCSS are delays in due contributions. Currently, nearly 16% of employers and 46% of independent workers have debts with the CCSS (Presidencia de Costa Rica, 2016), a situation that contributes to the system’s financial vulnerability.”
Source: OECD (2017), OECD Reviews of Health Systems: Costa Rica 2017, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264281653-en.
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Page last updated Nov. 11, 2022 by Doug McVay, Editor.