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A history of commitment to health and social reform has yielded for Costa Rica the best health outcomes of any country in Latin America.  These outcomes are the result of a well-developed publicly funded comprehensive health care system built on the principals of universal coverage and equity.  While the fundamentals of this system were becoming entrenched, several predictable challenges arose.  Costa Rica is confronting those problems with outside aid in a period of reform, which began in 1994.  Now, the World Bank has decided to support Costa Rica with its Second Health Sector Strengthening and Modernization Project, which will build off of existing initiatives and trends toward improvement of the health care system.  While Costa Rica occupies a tight niche as a small country of middle wealth and high social solidarity, the development of its health care system still holds lessons for some of the most complex nations of the world. 

 

The Costa Rican Health Care System

 

Framed by Nicaragua to the north, Panama to the south, and the Pacific Ocean and Caribbean Sea, the small country of Costa Rica (area 51,100 sq. km)stands out from its neighbors with a deep history of commitment to social reform and a thriving economy.  With a population of only 3,810,179, 59% of which live in urban areas,the nation is not only small, but also it has been able to hold social solidarity.  This solidarity arose from the nation’s agricultural history in which the upper and lower classes were dependent upon each other. In the past decade the ratio between the income of the upper 20% and the lower 20% held stable.[iv]  The democratic government composed of executive, legislative, and judicial branches, and a four-year rotating presidency, has also shown remarkable stability.  Sustained economic growth has built a GDP per capita of USD$8,500 in 2001 with the primary industries being services, industry, and agriculture.  The development model, “Based on promoting exports and tourism and modernizing state institutions in the 1990’s,” as landed Costa Rica in 41st position in a 1999 development survey of 162 of the world’s wealthiest countries.

 

A primary contributor to Costa Rica’s success has been its focus on the well being of its people.  For Costa Rica, health and education are priorities for the success of their nation.  The World Bank highlights this priority:

 

“The Government of Costa Rica sees the health sector as an essential determinant of the country’s economic and social development, giving it a priority that is manifested in sustained high levels of spending and active policy attention at the highest levels.”