In building this nation state, Costa Rica has been exemplary in fortifying its foundation for centuries; inclusive of the 1949 permanent constitutional abolishment of its army to the inspiring Nobel Peace Prize award conferred to former president Dr. Oscar Arias Sánchez for his work in Central America. Dr. Arias’s legacy and philosophy lives on today through the people of Costa Rica’s commitment, ingenuity and passion for their country.
Introduction
Costa Rica ~ a country bound by the Caribbean Sea and the North Pacific Ocean, between Nicaragua and Panama. This mesmerizing, tropical bliss is home to the oldest Democracy in Latin America and internationally recognized for its coffee, exotic fruits, sugar and ornamental plants production. And, of late, Costa Rica has also been developing its economy to include a strong technology sector and a world-renowned tourism industry.
Recently, the Medical Tourism Association™ (MTA) collaborated with Costa Rica’s PROCOMER, the Foreign Trade Corporation of Costa Rica in organizing and hosting a four day Costa Rica Country Spotlight and Familiarization (FAM) Trip. International delegates from the United States and Canada flew Continental Airlines, an official sponsor of this trip into Costa Rica’s Juan Santamaria International Airport.
Upon arrival, delegates were greeted by PROMED representatives and transported by Grayline Costa Rica to Barceló San José Palacio, a 5-star hotel, centrally located in San José. The following highlights this FAM trip in brief.
Government Support at the Core
Many healthcare clusters around the world are shining examples of Private Public Partnerships (PPP) offering a myriad of healthcare services and a spectrum of spa & wellness choices for medical and health travelers.
In some instances, the development process for a specific medical tourism destination may be catalyzed by a private sector hospital, or jointly catalyzed by both the private and public sectors. Costa Rica is one such example of a PPP that continues to thrive and expand, with government support at the core of this country’s medical tourism industry growth.
PROMED, the Council for the International Promotion of Costa Rica Medicine, is a non-profit organization that coordinates and orchestrates the government’s efforts. Its two-fold mission is that of monitoring and ensuring Costa Rica’s healthcare system’s national quality levels, and, promoting the country’s healthcare capabilities as a healthcare cluster globally.
As part of this mission, PROMED also advances the adoption of international accreditation standards and initiates ongoing education for medical tourism providers inclusive of medical, dental, government, hospitality and tourism sectors throughout Costa Rica. Comprehensive support of this nature appears to go a long way in positioning Costa Rica as a medical travel destination and healthcare hub.
Earlier this year, in April 2010, PROMED organized an inaugural Latin American Global Medicine & Wellness Congress, in San José, at the Ramada Hotel Plaza Herradura Convention Center. The primary focus of this event was to draw the interest, attention and participation of the medical tourism industry’s key stakeholders inclusive of medical tourism facilitators, insurance company executives, hospital and clinic physician leaders, resort and hotel general managers and the region’s government officials.
In launching this Congress, PROMED introduced the region to its major North American target markets of the United States and Canada. In the words of Mr. Jorge Woodbridge, Costa Rica’s former Minister of Competitiveness, “Fostering spaces like this, which promotes the offer of health and wellness services in Latin America encourages the consolidation of global medicine which helps position the region as one of the best health systems on the globe, as well as strengthening the initiatives developed by the country.” This is just one example of what proved to be an effective convening in the region for the medical tourism industry.
As a partner to this Congress, the MTA fully supported the event as CEO Jonathan Edelheit was on hand to lend industry expertise in the area of insurance perspectives within the medical tourism industry. Other speakers and a sampling of modules covered included medical services marketing in North America, retirement living, role of travel agencies & airlines, international patient departments, branding, and role of sector wide technologies as country-attraction tools.
PROCOMER, Costa Rica’s Foreign Trade Corporation of Costa Rica, is also a non-governmental public agency. A second example of government support at the core, PROCOMER facilitates the development of Costa Rica’s production sectors, and supports these sectors respective export capacity in promoting Costa Rica’s products into world markets. By way of background, when MTA was approached by PROCOMER about this recent four day fam trip, it was clearly innovative in design from the start.
Central to bringing this in-country experience full circle was allowing the buyers to meet the medical professionals & staff, and visit their hospital & clinic facilities, while including government officials and hospitality industry representatives. In essence, stakeholders that embraced the booming medical tourism industry in Costa Rica were included, present and accounted for.
In terms of schedule, MTA provided a Medical Tourism workshop prior to individual site tours, for both buyers and healthcare service providers. In addition to industry know-how, buyers and providers enjoyed this opportunity to network, present their spectrum of health services offered, provide information about respective business models, and field Q&As.
In addition to the fam trip delegates, service provider attendees included PROMED, Costa Rica MD, CR Medical Solutions, Hospital Clinica Biblica, Mind & Health – CRMedicalTourism, ConsuHotel, Clinica UNIBE, New Smile – Costa Rica and el Colegio de Dentistas (Costa Rica’s College of Dentists).
An Array of Strengths and Assets Comprise Costa Rica’s Healthcare System
Historically, one aspect where Costa Rica differentiates itself in the Latin American region is the country’s advanced development of its state-based health system. Through its national health policy efforts, social access and healthcare delivery is widely afforded to the people of Costa Rica. The country’s national health system includes the Ministry of Health (MOH), the Costa Rican Social Security Agency (CSSA) and the National Insurance Institute (INS).
Combined, these three agencies maintain standards for population health status in Costa Rica, which only serves to reinforce Costa Rica as one of the world’s most attractive destinations for medical tourism services.
By way of background, nearly 80% of Costa Rica’s medical professionals completed their studies abroad, either in the United States and/or Europe. Most of the doctors and the country’s medical staff are conversant in English. On this FAM trip, one of the delegates asked about pediatric services and learned that the “Hospital Nacional de Niños” (The National Children’s Hospital), located in San José, Costa Rica handles the majority of the country’s pediatric cases through direct access and/or referrals. Since its founding in 1845, this 250-bed pediatric hospital has been treating children under 12 years of age.
In terms of accreditation, The International Society for Quality in Health Care (ISQUA); a non-profit, organization with members in over 70 countries, is assisting Costa Rica with technical and policy advice. Evidence based protocols are being employed and best practices established; all of which improve overall health standards and quality of health services in Costa Rica, while contributing to knowledge sharing as part of the World Health Organization’s (WHO) country initiatives.
Joint Commission International (JCI) has also been working with Costa Rica’s Ministry of Health and in country health care organizations. Other, more specific accreditation bodies such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) assist in assuring patient safety within an ambulatory surgery setting among service providers in Costa Rica.
Dr. Lawrence S. Reed, President of AAAASF, commented, “Through our subsidiary, Surgery Facility Resources, we are expanding our international role as medical tourism grows. In Costa Rica, we are working with government agencies and other support groups such as the MTA. These efforts are aimed at assisting our international colleagues, who appreciate that our only goal is patient safety.”
Dr. Reed also acknowledged and recognized that “Both Dr. Ronald Iverson and Executive Director Jeff Pearcy have put tremendous efforts into this area. The progress that they have made in a short time is truly remarkable.” AAAASF has been instrumental in providing a forum for discussion of new ambulatory care concepts and distributing relevant information on this subject within the medical community and public-at-large.
Another accreditation agency, The Accreditation Association for Ambulatory Health Care (AAAHC), which was founded in 1979, accredits ambulatory health care organizations inclusive of ambulatory surgery centers, office-based surgery centers, college student health centers, managed care organizations, military health care clinics, and large medical & dental practices.
In all of its survey and accreditation program work, AAAHC designation is recognized as a symbol of quality by third-party payers, medical organizations, liability insurance companies, state and federal agencies and the public.
AAAHC’s international accreditation program has been implemented in Costa Rica. Finally, the Costa Rican Standards Agency (INTECO) is currently developing a Quality Seal for specific medical recovery centers and any other tourism services as relates to the medical tourism industry.
Medical and Dental Facility Site Visits Reinforce Quality Comes First
The Costa Rica FAM trip introduced our delegates to a host of medical and dental facility site visits. Simply put, all of the facilities reinforced and demonstrated a key message ~ that quality comes first. We visited Prisma Dental, Pino Plastic Surgery, DentaVac Dental Clinic, Hospital Clinica Biblica, Hospital ~ Hotel La Católica, and CIMA San José.
Beginning with Prisma Dental, which offers a full range of customized services including dental implants, cosmetic dentistry and full mouth reconstruction; Drs. Rubinstein and Cordero shared with us that “over 80% of their clientele travel to Costa Rica for dental care services from North America and Europe”. Internationally accredited by AAAASF, Prisma Dental’s staff is 100% bilingual, and their clinic is set up as a one-stop-shop; where crowns are constructed onsite in the lab, enabling added efficiency for dental patients traveling from abroad.
Another AAAASF center, Pino Plastic Surgery Clinic, located in San José offers aesthetic surgical services to medical travelers. Guided by the leadership of U.S. trained Dr. Ronald Pino, this clinic upholds the highest quality standards in medical service quality.
Pino Plastic Surgery Clinic constructed the clinic with medical equipment imported from the U.S. in accordance with the Food and Drug Administration standards; and Dr. Pino is a regular contributor to the American Society of Plastic Surgeons Society (ASPS).
We were greeted with a comprehensive presentation on services offered and patient testimonials at DentaVac Dental Clinic. In operation for over 22 years, DentaVac Dental Clinic provides services in dental hygiene, cosmetic dentistry, periodontal and dental implants.
The DentaVac team stand behind a guarantee of precision and high performance in their work. The clinic remains committed to leading edge technologies through usage of an intra-oral video camera system, metal free porcelain crowns, and state of the art dental implants. Our visit with Hospital Clínica Bíblica began with a sponsored networking dinner at Tiquicia, a typical Costa Rican Restaurant in Escazú.
Squeezed in between enjoying breathtaking views of San José, entertainment by folkloric dancers, and a gourmet dinner, our delegates were provided the opportunity to become acquainted with key staff of Clinica Bíblica’s International Patient Department.
Later, on site at JCI-accredited Clínica Bíblica, we were greeted by Lorena Morera, Brad and Bill Cook who lead the hospital’s International Patient Department. This site visit included the opportunity to meet all of Clínica Bíblica’s international patient coordinators, hear about the hospital’s historical roots and learn about current medical services. A longstanding member of MTA, Hospital Clínica Bíblica has been featured in the first patient documentary about the Medical Tourism Industry, entitled Angels Overseas.
Chronicling the medical travel experience of Bob, an American patient overseas; who goes to Costa Rica for a double knee replacement, the documentary details his trip, the surgical procedure, a short tour of Costa Rica, his rehabilitation process and return home to the United States. Bob is but one of the approximate 50 million Americans without comprehensive health insurance. This double knee procedure in Costa Rica amounted to a cost savings of $80,000.
Our site visit to Hospital – Hotel La Católica offered us an interesting perspective into the wellness niche in Costa Rica. Built in 1963 by a group of nuns from the Franciscan Sisters Congregation of Immaculate Conception along with a group of physicians, Hospital La Católica focuses on patients’ lifestyles, in promoting prevention that leads to overall health and wellbeing.
Plastic surgery, bariatric, orthopedics services are offered and Hospital – Hotel La Católica is home to the only hyperbaric chamber in Costa Rica. Hotel Posada El Convento, located inside Hospital – Hotel La Católica’s building encompasses 34 rooms resplendent with a modern spa, physical therapy area and a state-of-the-art Pilates studio. International patients and their travel companions can take advantage of these wellness services in addition to medical treatments in one convenient location.
Our final stop at another JCI accredited institution, CIMA San José, completed the portfolio of medical and dental facilities that we visited during this four day FAM trip. CIMA San José, is a three-story hospital constructed on two main levels.
The hospital facility comprises a large outpatient medical department, an array of advanced diagnostic and treatment services inclusive of chemotherapy and hemodialysis; a radiology department, a full-scale ER unit, trauma department, private consultation rooms, a fully equipped modern surgery department and corresponding recovery facility.
CIMA San José’s physical therapy facilities, plastic surgery practice, a spa, and several retail services are located on the ground level while the medical office building includes a 100-seat auditorium, conference area and the medical library.
Exploring Costa Rica ~ The Exotic Paradise
Our FAM trip delegates were treated to a full day touring Costa Rica’s Volcan Poás National Park, Doka Coffee Estate and Sarchí, Alajuela. With stunning rain forests, active volcanoes, and a wide variety of flora and fauna, Costa Rica offers a unique blend of natural beauty, ecological treasures and exhilarating adventures. 26% of the country’s national territory is protected in the form of national parks, private reserves and designated protected areas.
Conservation of these national resources is a top priority for Costa Rica, which has earned the country recognition as one of the world’s most precious global resources in terms of tourism. Adventure travel in Costa Rica can range from a bird’s eye view of tropical forests while zip-lining on a canopy tour, hiking through the luxuriant greenery of the rainforests, enjoying an invigorating white-water rafting trip or surfing the colossal waves of either coast.
As a leading eco-tourism destination, Costa Rica diligently upholds a commitment of responsible travel to the country’s fragile, pristine, and protected areas. The country as a whole also invests significantly in educating travelers on the country’s natural resources.
Funds are provided for ecological conservation which then directly benefits the economic development of local communities within Costa Rica. Eco-tourism as a niche in Costa Rica also works to ensure that future generations may experience aspects of this lush, untarnished natural environment.
There are currently 112 volcanic sites throughout Costa Rica, and the Volcan Poás National Park is one of the most visited and most protected destination in the country. As the mist and clouds part, one can appreciate the sulfuric, turquoise-toned mystical lake that is surrounded by smoke and steam rising from fumaroles. Water from the lake is constantly seeping through cracks on the hot rock beds, evaporating and building pockets of steam.
This crater is 1,050 feet deep and nearly 1 mile across. It is the largest active crater in the world. The trails within the Volcan Poás National Park wind through a cloud forest that is stunted and twisted, not only by sulfuric volcanic emissions but also by the cold windy high altitude habitat.
Lake Botos sits as an extinct crater at the end of one trail, and is home to over 79 different species of cloud forest birds including hummingbirds, tanagers, flycatchers, toucans, Costa Rica’s national bird the clay-colored robin, and the area’s most famous avian resident, the stunning quetzal.
One of the most intriguing ecosystems present within the park, is the dwarf or stunted forest, where the tough ferns and bonsai-type trees are not able to grow much in light of acid rain emissions from the active volcano.
We were indulged on this FAM trip with a visit to a coffee estate on this full day of sightseeing. Coffee production in Costa Rica has played a key role in the country’s history and as of 2006, coffee was Costa Rica’s number three export product. For several decades, coffee represented Costa Rica’s number one cash crop export. We visited Doka Coffee Estate www.dokaestate.com, home to one of Costa Rica’s highest quality coffees.
The Doka Coffee Estate is located on the fertile slopes of the Alajuela Poás Volcano, an area composed of rich soil, ideal altitude and climate; all of which have contributed to Santa Eduviges farm’s well-earned fame due to its excellent coffee products.
Doka Estate’s Three Generations Coffee is Rainforest Alliance Certified™, which guarantees that coffee beans are harvested responsibly. Farms assure protection to the environment and wild life, crop workers receive decent fair wages and benefit from reasonable working and living conditions, while their children and family members have access to schools, medical care and clean drinking water. We enjoyed a delicious lunch at La Cajuela Restaurant on the Doka Estate property, and then toured the coffee production facilities.
The Seedbed covers the development process of the plant up to the point of recollection of the ripe grain. The group was given a brief history of the estate, its owners, the production and varieties of plants, the geography of the area and the traditional ways of cultivating the grain. The oldest humid coffee processing plant, declared as an Architectural Heritage for Humanity in 2003, operates by hydraulic power.
One appreciates the first classification of the grains, followed by the process of de-pulping first and second quality coffee in the grinders. The natural honey of the grain is cut in the fermentation tanks and a process is carried out that significantly impacts the aroma and the taste of the coffee. Coffee that has been dried in the Guardiola or on the patios under the sun is stored in the warehouse. This grain is ready to be peeled, and then exported or roasted in the roaster.
Our delegates also had the opportunity to tour the roasting plant for Café Tres Generaciones, where each different type of roast was explained. Samples of each roasted product was then served and at the culmination of the tour, we had an opportunity to purchase this “Fabulous Fresh Roasted Costa Rican Coffee”. This is available for sale online and direct shipment to interested customers in the United States as well.
Neighboring Grecia, a few kilometers away is the picturesque town of Sarchí, Alajuela home of Costa Rica’s National Labor Symbol. Sarchí, is also known for its beautiful and intricate arts and crafts and souvenirs.
A key artisan town in Costa Rica, Sarchí is best known for the vibrant and pretty oxcarts that are handcrafted here and sold all over the country. A national iconic symbol of Costa Rica, the oxcart is a key symbol in the country’s history, as these were used to transport coffee beans to nearby and faraway markets. Highly ornate, these oxcarts are elegantly craved and usually painted with bright colors.
The largest and oldest oxcart factory is also found in Sarchí. The colorfully painted designs on modern-day oxcarts were actually the inspiration of an Italian artist who immigrated to Costa Rica. His paintings on the oxcart’s wheels quickly caught on and today the colorful geometric designs are hand painted on all the oxcarts, with no two designs exactly alike.
Throughout Sarchí, one will also find a wide array of wooden furniture and souvenir stores that sell everything from beautifully decorated bowls and trays to intricately carved wooden utensils, jewelry and masks. These items are usually meant for the local markets only, as they typically reflect Costa Rica’s diverse culture and country traditions.
The Springs Resort &Spa, best known for its hot springs is nestled next to the Arenal Volcano, just a few hours outside of San José. This property encompasses165 acres and is positioned 1,000 feet above the Arenal Valley. The Springs, as they are commonly referred to includes 18 freeform, landscaped pools, which consist of hot mineral water, captured from natural springs near the Arenal River and pumped up 420 feet to these pools.
Upon arrival at The Springs Resort & Spa, one is greeted by pleasant, welcoming and accomodating staff members. The five-story main building is built around a central staircase, connecting all floors with an open-airy atmosphere, providing breathtaking views of the active Arenal Volcano.
In addition to the Spa and Hot Springs, visitors can enjoy on site recreational activities including the wildlife preserve “Cat” tour, hiking trails, horseback riding, ATV tours and bird watching. There are four dining experiences for guests to partake in, offering everything from fine dining, a sushi bar and/or poolside grill selections.
The spa facility at The Spring offers onsite treatments utilizing natural ingredients from the rainforest and volcanic materials like therapeutic hot springs clay harvested from the property, tropical fruits and indigenous seeds. The Springs is recognized as one of the top rated spas in Costa Rica. After treatments, enjoy a hot tea in the Spa lounge or sit in the Wet Sauna for added relaxation pleasure.
The Spa also allows their guests to take advantage of the treatments and the Hot Springs simultaneously, by receiving an Aquassage; a massage in water at the Perdido Falls. Juxtaposed next to the spa facility; The Springs’ Fitness Center contains state-of-the art equipment which is made available to all guests interested in using the facility.
Simply put, this is an ideal property for medical travelers, health and wellness visitors to embrace as part of their overall Costa Rica experience either before or after a medical or dental procedure. During our visit to The Springs Resort & Spa, we coincidentally bumped into a patient we met a few days earlier at one of the dental clinics. This individual was relaxing for a few days prior to before returning to San José for the completion of her dental treatment.
Each Hot Spring is labeled specifically for the guests, detailing the benefits one can expect to receive when soaking in them. The pools are closed nightly by dusk; water in each of the pools is drained, cleaned and refilled early each morning. Additionally, the pool water is circulated through a filtration system, eliminating precipitated minerals and foreign contaminants.
Press Conference Unveils Costa Rica Future Plans
Towards the end of the FAM trip, a press conference was held at the Barceló Hotel in San José to discuss the event and what lies ahead for Costa Rica’s Medical Tourism Industry. Led by Dr. María Luisa Ávila Agüero ~Minister of Health; Mr. Jorge Sequeira ~ General Director of PROCOMER; and Dr. Jorge Cortes ~ President of PROMED they collectively acknowledged that within the next 5 years, Costa Rica expects to reach upwards of 100,000 patients inbound into Costa Rica seeking medical and dental care services.
Dr. María Luisa Ávila Agüero, Minister of Health, confirmed the Costa Rica government’s support in continued development of the medical tourism industry. She reiterated the 2009 declaration of National Interest, and corroborated that President Laura Chinchilla also supports the industry and the array of initiatives underway to stimulate further growth of Costa Rica’s medical tourism industry.
Dr. Jorge Cortes articulated PROMED’s push foward on international accreditation, and shared his view that medical tourism is not a passing trend. As demonstrated in MTA’s documentary, Angels Overseas, Costa Rica’s cost advantages alone approximate up to an 80% of savings in medical and dental treatments, thus providing a win/win/win solution for patients, healthcare buyers and Costa Rica healthcare service providers. Mr. Jorge Sequeira then took the stage and affirmed that PROCOMER will continue supporting medical tourism initiatives as well.
All of the delegates on this Costa Rica Country Spotlight and FAM trip were provided with this wonderful opportunity to interact directly with the country’s government officials, as well as provide firsthand testimonials of their positive impressions to members of the Costa Rican press attending the press conference.
In summary, it was a spectacular opportunity for healthcare buyer delegates to immerse themselves in Costa Rica’s high quality healthcare services, unparalleled tourism assets and genuine kindred hospitality of the Ticos, as the locals refer to themselves; in a country well on its way to establishing itself on the map of world-class medical tourism destinations.
