Costa Rica: Health System Overview - Health Systems Facts

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2017):
Public Coverage: 90.0%; Primary Private Health Coverage: 0.0%; Total: 90.0%

*”Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Annual household out-of-pocket payment, current USD per capita (2017): $185

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Jan. 10, 2020.
http://apps.who.int/nha/database/

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 2.6%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

“Costa Rica’s health care system is widely regarded as a success story. Its single-payer national health service was created in 1941 and has demonstrated considerable institutional stability since then. Costa Ricans have near universal access to a full range of health care services (including the most technologically complex, such as heart and lung transplants) and enjoy effective protection from catastrophic health expenditure. Life expectancy exceeds that in many OECD countries.

“But spending is on a steep upward trajectory, rising by around 7% per year in nominal terms, almost double general inflation, between 2011 and 2015. National health expenditure currently accounts for 9.3% GDP (remarkably, for a middle-income country, above the OECD average). This is mainly driven by strong increases in medical salaries, which have increased by 6% per year over the past ten years, much faster than productivity growth in the sector. Cost-containment mechanisms are poor, with little evidence that increased spending is benefitting patients. Frustrated by waiting times of a year or more for procedures such as children’s surgery, people are increasingly paying out-of-pocket for care in the private sector, creating the risk of two-tier system.”

Source: OECD (2017), OECD Reviews of Health Systems: Costa Rica 2017, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264281653-en
https://www.oecd.org/countries/costarica/oecd-reviews-of-health-systems-costa-rica-2017-9789264281653-en.htm

“The Ministry of Health is responsible for overall stewardship of the health system and, nominally at least, has ultimate responsibility for its governance. Health care services and health care insurance is largely delegated, however, to the Costa Rican Social Security Fund (Caja Costarricense de Seguro Social, CCSS). The CCSS is the main provider of personal health services, while the Ministry of Health (MoH) and specialised institutions linked to it are responsible for providing focused services to inhabitants with nutritional deficiencies and psychoactive substance addiction problems. In the private sector there are five insurance companies, co-operatives (non-profit organisations contracted by the CCSS, the self-management enterprises and the private clinics and hospitals. The Instituto Nacional de Seguros (INS – National insurance agency) operates both within the public as well as in the private sector and is responsible for covering occupational and traffic risks, as well as providing related hospitalisation, rehabilitation and trauma services.

“The right to health care services was originally offered to the working population – and with time has been extended to new beneficiaries affiliated to the contributive and noncontributive regimes of the system. These are categorised according to three distinct modalities of insurance:

“• Directly insured: employees, retired population from any of the state systems, people that individually or collectively are voluntarily insured, independent workers that contribute to the insurance and thee poor population (insured by the state).

“• Indirectly insured: families and people dependent on directly insured that have been granted benefits as family member.

“• Not insured: people with contributive capacity that do not pay social security, poor population lacking knowledge of their rights and undocumented migrants.

“Existence of the “not insured” modality has allowed inhabitants with contributive capacity to choose not to contribute to the social security. Both the Constitution and the CCSS Creation Law, state that that social insurance is universal, solidary and compulsory. There are no formal or legal mechanisms, however, that the CCSS currently uses to assure that all citizens and residents once they turn 18 years old will be enrolled on the system and contribute to it or will stay permanently on the system.

“However, people within this modality have the right to make use of secondary and tertiary medical services in case of emergency. Health care in Costa Rica is indeed a universal right to emergency attention and primary health care that no one can be denied. Moreover, all minors (under 18 years of age) and pregnant women without family beneficiary coverage, the retired population, HIV patients from the non-contributive regime and the people without contributive capacity (identified as such by the authorities) are insured in charge of the State.”