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Putting Country First ~ Costa Rica: The Challenges and Rewards of Creating a National Healthcare Cluster

Destination Spotlight
Competition is good. It breeds innovation and excellence, and it is the enemy of complacency. If Ford comes out with a bigger more fuel efficient automobile, then you can be sure that Chrysler will be hot on its heals (or wheels) with something even flashier. America was built on this type of dynamic tit for tat which in the end usually benefits the consumer with higher quality and lower prices. Sometimes, however, setting aside your differences, and working with your competitors for a greater good or common cause can ultimately result in more generous rewards for all.

It is the promotion of this concept ~ that the whole is greater than the sum of its individual parts ~ that has been the catalyst for the development of Costa Rica’s healthcare cluster.

So what is a healthcare cluster? And what benefits does it bring to Costa Rica, or any other country for that matter? A Healthcare Cluster is a geographic concentration of interconnected businesses and institutions serving the healthcare industry.

Industry clusters are usually made up of three levels:

(1) the core (or anchor) companies of an industry or industries that hold a competitive advantage (in our case this would be hospitals and clinics),

(2) related companies and industries that support the core (hotels, travel operators and medical/pharmaceutical suppliers), and

(3) the regional institutions and resources that support core companies’ competitive advantage (such as research institutions, skilled workforce, regional economic development policies, advanced infrastructure, etc.).1 The Silicon Valley, with its numerous computer technology related companies is a classic example of a technology industry cluster.

In Costa Rica’s particular case, the goal is to leverage the country’s healthcare infrastructure in order to be more competitive globally.

Costa Rica’s attributes are many:

  • It is located very close to the United States (only a 2.5 hour flight from Miami).
  • It has two Joint Commission International accredited hospitals, and is internationally respected for its healthcare system, medical professionals and infrastructure (Costa Rica was ranked ahead of the U.S in the World Health Organization’s 2000 report).
  • It boasts a highly educated population, many of whom speak English as a second language.
  • It is a stable nation with a long democratic tradition.
  • It possesses an experienced tourism industry (well versed in the art self promotion), with extensive infrastructure and services.
  • It is currently (and has been for many years) a “hot” destination for North American travelers.

In the Beginning…

Over the years, medical service providers in Costa Rica such as hospitals and clinics have been stuck in their own little bubbles, individually marketing their services to overseas patients and companies. Support services such as hotels, recovery retreats, spas, and transportation/tour operators have followed this model as well. Meanwhile, the public sector watched with curiosity from the sidelines, not sure what to make of this new phenomenon called medical tourism.

The truth is that medical tourism is not new to Costa Rica. For many years, starting as early as the 1970’s, a few intrepid plastic surgeons started marketing their services to North American patients. This trend continued through the 80’s and 90’s with the addition of cosmetic dentistry.

During this time the number of North Americans retiring in Costa Rica increased exponentially, due in no small part to the high quality of healthcare available. Some of these retirees had heart conditions; others required hip and knee replacements, and pretty soon, word of mouth got back to their friends in the States that Costa Rica had some darn good doctors and excellent medical facilities. Oh yea, and the prices were pretty sweet as well.

Fast forward to 2005. Medical tourism starts to gain momentum as U.S healthcare costs skyrocket out of control. Though still a trickle, an increasing number of people are flying to Costa Rica for more critically necessary procedures such as hip and knee replacements, hernia repairs and neurosurgery procedures.

In 2006, Clinica Biblica Hospital, Costa Rica’s first and largest private hospital begins a concerted effort to promote the high quality of its facilities and medical services abroad. This includes seeking Joint Commission International accreditation (obtained in January 2008); the launching of a new website for international patients, and the expansion of an office dedicated to promote the hospital’s international services and manage the overseas patients’ experience. Up until then, most international patients passing through the hospital were expats, overly adventurous tourists, or people flying from abroad seeking cosmetic procedures.

At the same time, the hospital aggressively began courting medical tourism facilitators, joined the Medical Tourism Association, and, led by Dr. Jorge Cortes, its medical director, and Brad Cook, the international department administrator, began to attend and promote itself at medical tourism congresses abroad.

These initiatives bore fruit quickly, as from 2006-2008 the number of overseas patients to Clinica Biblica Hospital doubled and then tripled, leaving little doubt to hospital administrators that in time, Costa Rica could become a prime medical tourism destination.

Meanwhile, CIMA and La Catolica, Costa Rica’s two other main private hospitals were not sitting idle. Founded in 2000, CIMA had long been a beneficiary of the many cosmetic surgery patients flooding into the country, and was now looking to take advantage of the increasing flow of patients looking for more critical care procedures.

To this end CIMA began expanding its facilities and also sought JCI accreditation which it received in mid 2008. Though smaller and less well-known, La Catolica also began to market it its services abroad, renovated its hospital, and even included an in-house patient hotel.

All of this activity was not happening in a vacuum. Ripple effects were being felt at recovery retreats, hotels, tour operators, transportation services and at the government level. As early as 2006, at the behest of Jorge Woodbridge, Costa Rica’s Minister of Competitiveness, Dr. Jorge Cortes was invited to participate in several meetings to discuss, among other issues, the feasibility of forming a healthcare cluster and converting Costa Rica into a medical tourism hub.

Though no definite action came out of these meetings, the government was already starting to formulate a strategic plan that would culminate in the creation of an association to promote Costa Rica’s healthcare services abroad. This was not an easy task as it meant bringing together diverse entities within the public and private sector, including the country’s health ministry, the tourism bureau, Acroprot (Association of Tourism Professionals), Procomer (The Foreign Trade Corporation), Cindi (The Costa Rican Investment Board), hotels, tour operators, and Costa Rica’s three primary private hospitals among others.

The tipping point came in January of 2008 when government representatives met with the U.S based Medical Tourism Association. Spurred to take action by the upcoming World Medical Tourism Congress in San Francisco, PROMED, Costa Rica’s very own medical tourism association was born.

Walking the Talk

PROMED is now leading the charge to consolidate the country’s various healthcare offerings into one united front. As the official board for the promotion and quality assurance of Costa Rica’s healthcare industry, it plays a multifaceted role as organizer, validation entity, watchdog, and promoter of Costa Rica’s healthcare initiative.

As further proof of the country’s commitment to position itself as a leading international healthcare provider, Costa Rica’s government recently declared the initiative an issue of national interest. This means government funding will now be allocated to strengthen and develop the country’s current healthcare infrastructure, as well as to target and promote specific medical procedures and healthcare niches such as retirement communities and rehabilitation/spa centers. An aggressive government sponsored marketing campaign is expected to be launched in the coming months.

Nevertheless, the government’s role is expected to be that of a referee and supporter: guaranteeing that quality standards are maintained, defining the rules of the game, and eliminating potential bottlenecks with regards to human resources, technology, infrastructure, and immigration that could hinder the development of the healthcare cluster.

The real players here are those in the private sector. Hospitals, medical equipment suppliers, the lodging and travel industry, universities; all must take an active role to ensure the viability of the cluster for the long-term, particularly amidst the whims and unpredictability of politics (a new government will be elected in 2010). According to Minister Woodbridge, “an uncompromising attitude towards quality and transparency is crucial for the long-term success of Costa Rica’s healthcare cluster initiative”.

So is All this Effort Worthwhile?

It all comes down to demographics. According to the U.S Census Bureau, between 1997 and 2025 the number of U.S citizens over the age of 60 will increase by nearly 90 percent. The elderly population (those 65 and over) is expected to double between the year 2000 and 2030.2 Add to the mix the nearly 50 million uninsured or underinsured Americans ~ only a stone’s throw away ~ and you can see why Costa Rica is shoring up its healthcare service infrastructure.

The benefits of developing a successful healthcare cluster include:

  • An increasing and reliable stream of outside income flowing in.
  • Greater profits for the healthcare sector and related businesses (medical suppliers, the pharmaceutical industry, hotels, restaurants, travel operators, and airlines).
  • An increasing number of high quality employment opportunities for medical professionals in the healthcare sector.
  • Higher hospital standards and service offerings for both international and local patients.
  • Competitive healthcare costs.

Let’s put it this way, if Bob, your neighborhood barber, is charging you $500 dollars for a haircut, but you know for a fact that in the next county barber Jim is offering the same haircut – with a shampoo and manicure, for only $100 dollars, then there’s a good chance that barber Jim will be receiving a lot of your business. Heck, it would only make good business sense for Jim to train a few more barbers, add some extra furnishings, and apply a fresh coat of paint to his shop.

Costa Rica wants to be your ‘barber’, and in the process of making you look and feel good, the country is betting that it will also gain from increased economic prosperity and better employment opportunities.

The Challenges Ahead

Bringing together such diverse entities, both public and private, and getting them to work together under a common banner will continue to be a challenge. PROMED wants to be as inclusive as possible, while at the same time maintaining a high bar for admission into the association.

To this end, a “quality seal” will be issued to all PROMED members, signaling to the consumer that a particular doctor or clinic has been vetted and meets certain requirements and standards. Hospitals and clinics in particular, will also require international accreditation in order to make this initiative sustainable.

However, some difficulties still remain, chief among these are the ability to maintain a sustainable pool of educated professionals (such as doctors, nurses, and technicians), and finding ways to ensure that the entire healthcare sector is transparent with regards to quality and pricing. The strong leadership provided by minister Woodbridge and Dr. Cortes (PROMED’s President) will continue to be key to solving these and other challenges that come along on the road to making Costa Rica’s healthcare cluster a success.

A taste of things to come was recently showcased at the 2008 World Medical Tourism Congress in San Francisco, where in stark contrast to most other hospital’s isolated initiatives, Costa Rica presented a united front that included its three top private hospitals and the Tourism Board, all flanked by an enormous, colorful backdrop that featured stunning nature motifs intermixed with images of Costa Rica’s healthcare infrastructure.

The message is clear: Costa Rica is determined to leverage its already formidable healthcare infrastructure in order to become as attractive to overseas patients seeking medical care, as it currently is for tourists seeking exotic vacations.

A patient coordinator for Hospital Clinica Biblica International Department in Costa Rica, Bill Cook oversees operations and customer relationship management initiatives aimed at increasing customer loyalty and satisfaction. Bill also oversees web content development and marketing strategy for Medical Tours Costa Rica, a locally based medical tourism operator. Bill can be reached at

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