“Three consecutive health reform periods mark Costa Rica’s UHC development process between 1940 and 2000. During the first period (1940–1960), the social security fund (Caja Costarricense de Seguro Social, CCSS) was founded based on social protection for manual and ‘white-collar’ workers. The scheme was included in the country’s Constitution from the outset. During the second period (1961–1980), the CCSS was mandated to make its coverage universal within a period of 10 years. The Hospital Transfer Act of 1973 transformed the CCSS from a merely financing institution into the main hospital care provider in the country. At the time, primary health care was being provided by the Health Ministry, particularly in marginal urban centres and rural areas. During the third period (1981–2000), primary health care was integrated into the CCSS scheme through the establishment of health posts throughout the country in proportion to the population. From that moment on, the Health Ministry would strengthen its role as health system steward, which it already had in formal terms since 1983. By the end of the century, Costa Rica had evolved into an upper-middle economy, and the CCSS transformed into the single, universal and comprehensive health care financer and provider it is today.”

Source: Vargas, J.R., Muiser, J. Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940–2000). Health Res Policy Sys 11, 28 (2013). https://doi.org/10.1186/1478-4505-11-28.

“A middle-income country with a population of 4.8 million, Costa Rica has the third-highest life expectancy in the western hemisphere (behind only Canada and Chile), at seventy-nine years. ¹⁰ Measures of maternal mortality (25 per 100,000 live births), infant mortality (8.5 per 1,000 live births), and under-five mortality (9.7 per 1,000 live births) are all low and have decreased consistently over the past twenty-five years. ¹⁰ Among low- and middle-income countries, Costa Rica performs in the top 10 percent on critical indicators of effective primary health care coverage and high-priority health outcomes, such as the proportion of children who receive appropriate diarrheal treatment and adult mortality from chronic diseases. ¹¹ Remarkably, Costa Rica achieves this quality while spending less than the world average for health care, both per capita (US$970) and as a share of gross domestic product (9.3 percent). ¹⁰

“Foundational to Costa Rica’s primary health care system is its Equipo Básico de Atención Integral de Salud (EBAIS, or basic integrated health care team) model, which was initiated in 1995. In the early 1990s Costa Rica’s primary health care system was suffering: The global economic downturn in the 1980s had drastically increased Costa Rica’s debt, and austerity plans cut funding to the country’s primary health care programs—resulting in low public satisfaction and quality of care. ^12–15

“In response, Costa Rica undertook a major reform of its health care system in 1994. The reform emphasized creating a new, robust primary health care delivery model—multidisciplinary EBAIS teams, each of which would serve a geographically empaneled population—that could provide the four critical functions of primary health care: first-contact access, comprehensiveness, continuity, and coordination. ^16,17 The reform organized Costa Rica’s primary health care system into seven health regions, each of which contains approximately a dozen health areas (geographically similar to counties). Within ten years, Costa Rica had not only designed and implemented a new national primary health care system, but it had also seen real results. In the first twelve years after the reforms, the proportion of the population with access to primary health care increased from 25 percent to 93 percent, ¹⁸ and in the first seven years after the reform, infant and adult mortality declined significantly (by 8 percent and 2 percent, respectively). ¹⁹“

Source: Madeline Pesec, Hannah L. Ratcliffe, Ami Karlage, Lisa R. Hirschhorn, Atul Gawande, and Asaf Bitton. Primary Health Care That Works: The Costa Rican Experience. Health Affairs 2017 36:3, 531-538.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated May 20, 2021 by Doug McVay, Editor.