Costa Rica is a small country, with just 51,100 square meters of territorial extension, located in Central America and with an estimated population of 4,565,693 habitants, as of 2010. It has been internationally recognized for its peaceful traditions, as it abolished its military force more than 50 years ago, and for its interest in preserving its natural resources, considering that in its small extension it holds close to 5 percent of the planet’s biodiversity, and is one of 14 countries in the world that has more than 23 percent of its territory under some kind of protected wildlife program. Its efforts have been recognized for Government investment in strengthening social security, and improving education, housing and health for the general population.
To be able to understand the current health care situation in Costa Rica, it is necessary to provide a brief history of Costa Rica , a review of the evolution of health care services in the country, particularly during the 20th century.
Historical Evolution of Healthcare Services
The Costa Rican population was one of the poorest and most underdeveloped of the Central American region, from the time it was a province for the General Captaincy of Guatemala during the Spanish domain in the region (1540-1820).
Historical registries from that time describe Costa Rica as the “poorest and the most under populated structural variant in the isthmus, based on subsistence farming and cattle breeding. There was a constant threat of diseases from unknown origin, without clear prevention plans, whose treatment and evolution were as uncertain as its consequences”.
Care services for the population were characterized by limited public assistance and charity works from different religious organizations. Historical registries from the beginning of the 20th Century described the impact on the population that infectious diseases, low life expectancy at birth, and high mortality rates for infant and mother had on the population.
During the first half of the 20th century, the beginning of Public Health Care Programs started for the care of patients with ankylostomiasis (hookworm disease), sexually transmitted diseases, anemia and tuberculosis, among many other illnesses. As a result of development and increased social security efforts in the second half of the XIX Century in Europe, an initiative to adopt similar programs in Latin American countries was promoted during the OIT’s V Pan American Conference in the year 1923, which took place in Chile.
In 1941, Costa Rica passed the law for the creation of the Caja Costarricense de Seguro Social (Costa Rican Social Security Institution), for providing healthcare to the working class. In the year 1947, they included insurance for disability, the elderly and death.
In the enactment of the Political Constitution of 1949, healthcare services granted by the Caja Costarricense de Seguro Social were proclaimed as constitutional right. In the year 1956, coverage is extended to the family members of an insured worker and five years later in 1961, universal nature of social services for all the country’s population was established in the Magna Carte.
In the second half of the 20th century, important advances were made in the strengthening of primary health care attention through the control of infectious diseases with the introduction of vaccination programs, access to drinking water, waste management, promotion of health with emphasis in adequate nutrition and care of children, in urban and rural settings.
Demographic and Epidemiological Transition
Starting in the second half of the 20th Century, Costa Rica underwent important demographical changes and is currently in an advanced demographical transitional stage, characterized by a process of relative aging in the population that will continue in upcoming years.
According to the Pan American Health Organization, Costa Rica has the highest life expectancy at birth in Latin America (79 years for both genders), with a median age of 73.9 years and 72.9 years in the Central American Isthmus. The population’s pyramidal structure has changed drastically in the last decades, broadening in the middle. These changes are explained by a sharp decrease in mortality rates and fertility (the lowest in the Central American region and one of the lowest in Latin America).
Concerning infant and mother mortality rates, Costa Rica has shown a clear trend towards decreasing rates for both indicators during the last decades, currently presenting the lowest numbers for the Central American Isthmus and one of the lowest in the continent. The main causes for morbidity and mortality in the country since the seventies are non-communicable chronic diseases, mainly in the circulatory system and tumors (both account for more than half of all deaths reported in the country nowadays). The third cause of death is due to traffic accidents and violent deaths.
Mortality rates for communicable diseases are the second lowest in the continent, only surpassed by Canada. The trend for these types of diseases in the country has shown a clear decrease in the last forty years.
Resources, Access and Coverage Indexes
Concerning resources available for health care services, Costa Rica systematically presents the best indicators in the Central American Isthmus. The country reports one the highest ratios of doctors and nurses per habitant in the Central American region, as well as hospital bed per habitant ratios.
Costa Rica presents favorable economic indicators, which may explain the country’s current health status. It has the highest percentage of literate population in the isthmus and one of the best in Latin America. The same happens with the national gross income in American dollars per capita and the access of the population to better sources of drinking water and waste management.
In brief, the country’s favorable healthcare status is explained through the improvement of social and economic conditions that the country underwent in the last few decades, the strengthening of primary healthcare, as well as health services in general and the advances shown in the sanitary infrastructure of the entire country. The current challenge, as mentioned in one of the latest reports of the nation, is not only to advance to higher levels of development, but to sustain the goals achieved.
Pan American Health Organization, Health Information and Analysis Project. Health Situation in the Americas: Basic Indicators 2009. Washington, D.C., United States of America, 2009.
Pan American Health Organization, Health in the Americas. Country volume Washington, D.C., United States of America, 2007.
Costa Rica ~ A View of its Healthcare System
About The Author
Dr. Adolfo Ortiz is a Health Physician and works in the Integral Attention to Cancer Strengthening Project, Caja Costarricense de Seguro Social. He is an Epidemiologist Doctor in Hospital Clínica Bíblica, the longest running private health care institution in the country. Also, he is an Instructor Professor in the under graduate and graduate program in the University of Costa Rica. He has participated and published investigations concerning the epidemiology of cancer, locally and internationally, and has been invited as a speaker and advisor in health issues for national and international institutions.