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Costa Rica 2018 | HEALTH & EDUCATION | REVIEW: HEALTH

Costa Rica's public healthcare system is one of the best in Latin America, but funding issues have led government leaders to carefully seek new private partnerships and decentralize key networks in order to maintain quality care.

Costa Rica's healthcare system is widely regarded as one of the best in Latin America, with the nation a regional example for quality in both the private and public sectors. The Costa Rican Social Security System (CCSS), the nation's socialized healthcare system, has made tremendous strides in expanding access to quality healthcare to the entire population, laying the foundation of development that has raised the nation's standard of living to among the best in the region over the past three decades. On the private sector side, the number of private clinics has grown significantly in recent years as foreigners have flocked to Costa Rica for low-cost procedures. Well-established links between Costa Rica and key foreign markets and the nation's reputation as a hub for high-quality care have made the medical tourism field one of the nation's most important economic sectors. Moving forward, industry leaders are focused on expanding services in the face of growing public debt and ensuring that the nation remains at the cutting edge of medical treatments.

Costa Rica's health outcomes have risen to the top of Latin America thanks to high levels of public investment. According to the CIA World Factbook, Costa Rica's life expectancy of 78.7 years was behind only Panama and Chile for the best mark in Latin America. Wider access to healthcare has led to 99% of all births being attended by skilled healthcare workers and corresponding significant decreases in the under-five mortality rate and the maternal mortality ratio to the point that each are well under the average for Latin America. These figures formed two of Costa Rica's Millenium Development Goals, all of which it accomplished. The others included getting HIV/AIDS deaths under 3.0 per 100,000 people, lowering deaths due to tuberculosis among HIV-negative people, and eliminating deaths from malaria.

The nation's success with healthcare can be traced back to the creation of a centrally run universal healthcare system. The CCSS was first founded in 1941, but the Costa Rican government dramatically expanded its role in the 1970s, nationalizing all of the nation's hospitals and healthcare professionals and guaranteeing care for all citizens. The system had three tiers: seven national hospitals, 31 smaller regional hospitals, and a network of regional healthcare centers consisting of more than 500 clinics and around 1,000 basic attention units that offer primary care and basic diagnostic services. The system has been a resounding success throughout most of its history, meeting most needs at the primary level and allowing for efficient distribution of resources by focusing on technological investment at the upper level.

Today, however, the CCSS faces new problems primarily related to funding. Funds for the CCSS come from a mix of worker and employer contributions and state allocations; the proportion of each has shifted over the years to gradually become more dependent on worker contributions. The CCSS' splits insurance into sickness and maternity, disability, and non-contributory segments. While more than 85% of Costa Ricans are insured, growth from undocumented migrants has increased the number of non-contributors and placed new stress on the system. The government has struggled to meet its financial obligations to the CCSS during economic slowdowns in the past, and problems have started to reemerge as Costa Rica deals with rising levels of public debt.

The need to alleviate costs has begun to have direct effects on the quality of healthcare offered, with many hospitals delaying needed technology upgrades and changing staff scheduling practices, which has led to longer waiting times. The private sector has begun to play a bigger role in the system to meet needs in underserved regions and provide new standards of service for citizens looking for advanced care. The CCSS has begun to work jointly with some of these centers, and partnerships appear likely and necessary to ensure that the sector can continue to meet the country's needs. Industry leaders see new opportunities in the increased decentralization of the system, with basic health outcomes improved, more granular oversight to help CCSS centers better serve specific locations, increasing efficiency, and building a more flexible system that is better suited to move into the future.