Before I came to Costa Rica, I had the idea that socialized medicine was not effective. I think that in the US, we have only heard the complaints of those who come from countries with socialized medicine, and without having heard the positive components of social systems, we are unable to believe that it works. I hope that this post will provide you with part of “the other side” that we rarely hear. (Note: this post is again in large part thanks to Jorge, our professor who was trained as a physician and scientist, but pretty much can answer any other questions we can think of :) )
The system in Costa Rica is “Caja Costarricense del Seguo Social”, aka CCSS, or just “Caja”.
The health system of Costa Rica is based on 7 principles:
Universality: guarantees health protection of all inhabitants
Solidarity: each individual contributes to the system
Mandatory: contributions from individuals, employers, and the State
Unity: the population has the right to health care access
Equality: equal treatment of all citizens
Equity: equal opportunity for each citizen to receive care
Subsidized: earnings will be contributed, but the State will cover a deficit
These principles are exercised through three levels of care:
1st level: primary and preventative care, this is taken care of by what is known as an EBAIS (Equipo Básico de Atención Integral en Salud, more or less “Basic team of integrated health attention/care”). The EBAIS is a team of people working together to take care of the health of all the individuals in an area. A typical EBAIS serves 3.000-5.000 people in a community, and each EBAIS is made up of: a physician, nurse, medical records technician, and pharmacist technician. Sometimes there’s also an ATAP (Técnico de Atención Primaria, loosely “Primary care/attention technician”), who is basically a health care worker who gets to ride on a motorcycle to do home visits with people who can’t make it to the health center or those who miss their appointments.
Though the team of people is the actual EBAIS, since the EBAIS usually works in a permanent building, we also refer to the building as the EBAIS. When, fo whatever reason, a person can’t make it to the building, the EBAIS goes to the person via the ATAP. The ATAP is also responsible for doing child vaccinations and such.
There is usually a building where an EBAIS works permanently; however, if an area does not have enough people to have its own building, there are temporary buildings, where the EBAIS may visit once a week or once every two weeks.
Most of the EBAISes are painted a characteristic blue, but we have seen several that are painted a sort of salmony colored pink. This is because pink was the cheapest color paint at the time!
There are 893 EBAISes in Costa Rica.
2nd level: hospitals where appointments may be made with Pediatricians, Gynecologists, General Surgeons, and Internal Medicine physicians. Patients who need more specialized care than is given at the EBAIS receive referrals to the hospitals and clinics.
There are 29 hospitals in Costa Rica.
3rd level: specialized hospitals for specific needs…psychiatry, children, geriatric, women, and rehab.
There are 9 3rd level hospitals in Costa Rica.
That’s the basic structure. Next post will describe more about how it’s funded and how it functions. Until then, pura vida.