Costa Rica Healthcare System Comparison



son the Costa Rican healthcare system in comparison to healthcare in the United States I chose to examine Costa Rica for a few reasons first it's a great country to visit and you should go if you have the means second Costa Rica's health care system is unique in Central America third it ranks about the same as United States and overall health system performance according to a World Health Organization study done in 2000 with Costa Rica performing 36 in the United States performing 37th and since the countries are so geographically demographically and economically different I wanted to know how the system stood up to a side-by-side comparison when I first oh into this project I tried to make sense of the WHO rankings these rankings are based on a comparison of improvement of health of the population responsiveness of the healthcare system to population expectations and distribution of care and fairness and financing and financial risk prevention the paper explained the methodology behind these rankings and it's extremely dense and full of equations of distribution charts that didn't mean much to me so I took a broader look at how the United States and Costa Rica compare in those categories as a side note Costa Rica is an OECD partner country not a full member and so well I tried to be consistent in comparing the two system statistics from Costa Rica are pasted together from various sources this presentation will cover the history of the Costa Rican healthcare system Costa Rican attitudes toward health and healthcare healthcare system structure and market structure health of the populations and healthcare spending Costa Rica recognizes the right to life in 1973 the general health law was passed that declared the health of the population as a public good and holds the state responsible for maintaining it through the health care system Costa Rica has near universal health care with a 95% of the population covered in 2014 the five percent of people not covered includes poor refugees undocumented migrants indigenous groups not aware of their rights and poor individuals who should be subsidized but are not recognized as such all inhabitants have access to emergency services Costa Rica has a robust governance of Public Health Ministry of Health the government arm deals with management and political leadership health regulation research guidance and technological development in conjunction with the Ministry of Health or a number of partner organizations that monitor education nutrition child nutrition and care alcoholism and drug dependence research water quality sewage management risk prevention and emergency management and international cooperation healthcare and health insurance in Costa Rica are delivered and managed through the Costa Rican social security fund also called the CCSS the ccss is an entity independent from the Ministry of Health Costa Rica's path to universal health coverage started in 1941 with the creation of the CCSS this institution was established with the introduction of mandatory health insurance for city-dwelling lower income workers in the 1960s health insurance was extended to include all workers and their families and in the 1990s to include all uninsured people it provides coverage by combining social security schemes for four groups into a single national pool and is funded mainly by employer and employee contributions the four groups are salaried workers and their families self-employed workers and their families pensioners and any dependents fully subsidized beneficiaries participants are covered for wide range of services including preventive care rehabilitations surgery hospital stays clinical tests pharmaceuticals and maternity care no co-payments are required within the system the structure of the Costa Rican system emphasizes primary care and community engagement in 1998 the LAN decentralization created democratically elected community health boards called juntos to supervise local delivery of health care and to coordinate care and service needs with the CCSS primary care is delivered by integrated health care basic teams also called EBA is patients are assigned to teams based on their location each team serves around 1,000 households and there are 1000 teams spread out in every territory of the country they consist of at least one doctor one nurse one health care and are supported by higher-level personnel such as social workers or dentists this team is the gatekeeper to care in the system and will recommend escalation to higher levels of care if needed in addition to basic teams centers for integrated care provide intermediate care facilities to prevent hospitalizations outpatient secondary care and inpatient care is provided through ten major clinics twelve peripheral hospitals and seven regional hospitals tertiary care is provided by two national general hospitals these tertiary care hospitals can provide the most complex services including lung and heart transplants Costa Rica also has a growing number of private healthcare providers to reduce long wait times the CCSS sometimes contracts after these providers and people are increasingly seeking care from these private providers independent of the CCSS and paying out-of-pocket contributing to rising healthcare costs this also increases the risk of creating a hybrid public and private system the United States in Costa Rica have fundamental differences in how healthcare is delivered however with similar outcomes in health Costa Rica has a publicly owned monopoly with increasing hybridization of care that includes a small but growing private sector CCSS is the provider of health science and health care to the majority of the country well this has created a very stable and integrated system a number of issues have become apparent patients do not have a choice in who administers their care even though the CCSS is a public institution the Ministry of Health has little oversight there for reporting and accountability for quality care and financial transparency is patchy at best and the long term stability creates resistance to change a number of conditions have contributed to long wait times for appointments and up to a year for certain surgeries driving people to seek care from private practices a physician shortage has been manufactured by the doctors professional organization which has secured restrictions preventing the licensing of foreign doctors limitations on the number of medical trainees in school and the requirement that doctors only be posted to full-time positions also the health care teams are only open till 3 p.m. which reduces the number of appointments available for patients contrast the United States is a hybrid system consisting of a patchwork of private institutions a small number of public institutions pharmaceutical companies equipment companies etc value is placed on competition and freedom of choice insurance provided through public and private sources the Affordable Care Act with Medicaid expansion has placed unprecedented responsibility on public sources for health insurance one of the main barriers to care is high cost and lack of insurance surprisingly these differences in healthcare delivery are resulting in similar health outcomes life expectancy at birth and infant mortality are relatively equal in both countries it should be noted that in Costa Rica life expectancy increased from by 10 years from 1970 to 2015 with the expansion of health insurance populations of both countries are predicted to age over the next thirty five years placing strain on their respective systems and a comparison of workforce both countries are below the OECD average of 3.3 doctors for 1,000 people the OECD average of nurses for 1,000 people is 8.9 higher than Costa Rica's and lower than us both countries shoulder significant non-communicable and chronic disease burden in 2016 83 percent of deaths in costa rica and 88 percent of deaths the united states are a result of a non communicable diseases the highest percentage resulting from cardiovascular disease the second from cancers and the fourth from chronic respiratory disease risk factors for those diseases are present in relatively similar percentages of each population as well the city with the obesity rates hypertension rates and diabetes health care spending is on the rise in both countries as a result of these diseases and an aging population while the amount of spending are very different both countries are dealing with unchecked increases in cost employees and employers bear a lot of the cost in both countries in Costa Rica they pay directly into a public pool that covers everyone with minimal state contribution out of the OECD countries Costa Rica's are the largest percentages of out-of-pocket costs which is because people are seeking care outside the system in the United States employees and employers contribute to public funding by paying taxes which are placed in a trust they also pay for their own insurance at whichever level they can afford out-of-pocket costs come from co-payments deductibles and with no coverage self pay as you can see the WHO rankings are justified even though the causes are different both countries are facing challenges and health of the population accessibility and rising costs

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