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Health Care System of Costa Rica

Tuesday, November 13, 2018

$2.00

Wyvonnia Morgan

De'Onna Smith

Healthcare Plans (Public)

Historical Background

Prior to healthcare plans, hospitals were mostly shelters for pilgrims and very poor and sick people and were managed not by doctors but by religious orders.

Enquipo Basico de Atencion Integral de Salud (EBIAS)

CCSS

Ministry of Health

Mid 1990's established a delivery model- multidisciplinary EBIAS teams

Each team served a geographically empaneled population

Formed from existing primary healthcare personnel

and from taking over the MoH's last remaining

medical services.

Poorest rural zones

In remote areas, EBAIS teams are mobile, visiting health posts on a regular schedule.

Provided by the Social Security Administration

CCSS is the largest segment of the government

The CCSS today provides high quality healthcare for almost all of Costa Rica

Owned 1,045 hospital beds (1970)

Legislation transferred all public hospitals to

CSSS (1973), completed in 1984

1940 Ministry of Health was established

Owned 5,659 hospital beds (1970)

During the time of the transfer in 1973,

MoH only provided medical services to

primary health interventions mainly in rur-

al areas.

Responsibilities: Sectoral policy, licensing

health facilities, disease eradication

programmes, enforcing food and water

sanitation standards

Health Care Systems in Latin America

Costa Rica

Universal healthcare system: equality of access to needed services among covered individuals

Caja Costaricense de Seguro Social (CSSS) public system which covered most of the population

Ministry of Health supported those who could not afford private providers.

A universalisation law (1961) called for the removal of salary ceiling

1971 the Legislative Assembly removed salary ceiling

Many factors have contributed to the transformation of health care systems in Latin America

Objective factors: economic, health (demographic or epidemiological), political transitions,

and the global availability of technological and institutional or organisational innovations.

Ideological factors: changes in values regarding the role of health-care services in society and in the prevailing development paradigm.

The Policy

The policy goal seeks to cover the last remaining uninsured populations through expansion of the single, public fund.

The expansion includes new contribution requirements for own-account workers and migrants as well as tougher inspection and enforcement procedures.

Costa Rica has been one of Latin America's star performers in terms of extending the International Labour Organisation's (ILO) original social insurance model to the maximum possible.

All persons enrolled in the health insurance programme obtain the same rights to benefits.

The Right to Healthcare

The policy

The population

The major aspect of the policy is to bridge the gap between the two public sector blocks (MoH and CCSS) in quality of health care and financial protection for those needing it.

Healthcare services was originally offered to the working population

Overtime, services has been extended to new beneficiaries affiliated to the contributive and non contributive regimes of the system.

Directly insured: employees, retired population from any state systems, people that individually or collectively are voluntarily insured, independent workers that contribute to the insurance and thee poor population

Indirectly insured: families and people dependent on directly insured that have been granted benefits as family member.

Not insured: people with contributive capacity that do not pay social security, poor population lacking knowledge of their rights and undocumented migrants.

Consequences

Unintended

Intended

Lack of financial support from other developed countries

About 700,000 are without healthcare access

Long waiting periods

Death by infectious disease dropped by 98%

Everyone in one working household receives healthcare

Infant mortality rate has dropped by 69%

Life expectancy has increased by 15+ years

Changes

Issues

Ley de Procteccion al Trabajador 2000 (Worker Protection Law)

This law required independent (own account) workers to enroll in the CCSS social security programmes beginning in 2005).

Program Estrategico de Cobertura en Inspeccion (PRECIN; Strategic Coverage Inspection Programme)

This program added 120 new inspectors who ensured that employers and employees are making correct payments to the CCSS

Sistema de Informacion Geografico Patronal (SIGPA: Geographic Employer Information System)

Inspectors used this information system to zero in on the location of employers under-reporting payroll levels or falling into arrears in their accounts with the CCSS

At the time of the establishment of the EBIAS, the main roadblocks to full universalisation of the CCSS system was the existence of economically active populations not legally required to enroll.

Those who evade enrollment stresses CCSS finances by continuing to use emergency department services.

Many undocumented migrants, agriculture workers, and indigenous people lack access to healthcare.

Those regions heavily populated with indigenous people have the highest infant mortality rates

Immigrant employers are not required to pay for healthcare system

Large numbers of Nicaraguan immigrants contribute to the economy, taking many jobs that citizens and residents tend not to want

Ethical and policy dilemmas arose when providing medical care to immigrants and their families. Should Costa Rica get compensated with resources from richer counties for the care they provide?

References

Compared to the United States

Feasibility

The cost of healthcare has increased gradually over the years.

Health care coverage increased from 47.2% of the population in 1970 to 94.7% in 2014.

In 1980, was the fourth highest in the region.

The CCSS currently assures that all citizens and residents, 18 years old are enrolled in the system, contribute to it, or will stay permanently in the system.

Boddiger, D. (2012). Costa rica restructures health system to curb financial crisis. The Lancet, 379(9819), 883. Retrieved from http://nclive.org/cgi-bin/nclsm?url=http://search.proquest.com/docview/929067868?accountid=12713

Chapter 1: Health care needs and the health care system in costa rica. (2017). (). Paris: Organisation for Economic Cooperation and Development (OECD). Retrieved from ProQuest Central Retrieved from

Costa Rica - HealthCosta Rica - Health. (n.d.). Retrieved from https://www.export.gov/article?id=Costa-Rica-health

Pesec, M., Ratcliffe, H. L., Karlage, A., Hirschhorn, L. R., Gawande, A., & Bitton, A. (2017). Primary health care that works: The costa rican experience. Health Affairs, 36(3), 531-538. doi:http://dx.doi.org/10.1377/hlthaff.2016.1319

Chapter 3: Health care efficiency and sustainability in costa rica. (2017). (). Paris: Organisation for Economic Cooperation and Development (OECD). Retrieved from ProQuest Central Retrieved from http://nclive.org/cgi-bin/nclsm?url=http://search.proquest.com/docview/2114230168?accountid=12713

Costa Rica is decentralizing its health care due to government

relying upon private clinics and physicians to provide care.

In contrast, the United States is adopting a more centralized system with greater government responsibility for universal coverage.

In 2015, Costa Rica ranked 50th in relative healthcare expenditures to GDP, while the U.S. ranked 1st.

The United States ranked 38th in overall quality in the world, whereas, Costa Rica ranked 37th.

This system has increased life expectancy of the population to an average of 79 years which is higher than the U.S., which is an average of 78.

By 2025, more than 20% of the population of Costa Rica will be over the age of 60 years, resulting in an increased demand for health services and a smaller share of income contributions.

Similary, the U.S. age-dependency ratio will increase from 0.50 to 0.61, reflecting an aging population that will require even greater health resources.

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