Costa Rica: achievements of a heterodox health policy

2020

Public insurers have limited resources and are faced with a trade-off between individual and collective welfare. This results in rationing, which means some services are available while others are not; and translates into limitations in access to health care. Health care is a need everyone will face at some point, therefore understanding resource allocation to optimize access is vital. This dissertation focuses on contributing evidence in support of policies to achieve this. Costa Rica is a developing country with a public insurer providing universal health care coverage. The country's health outcomes are closer to developed nations than to its socioeconomic peers; all of which make it a valuable research setting. These insights contribute to the ongoing discussion of how to organize health care systems with limited resources while having the goal of maximizing coverage and access to health care.

2017

This document provides a preliminary assessment of the Costa Rican health system relative to the goal of universal health coverage, with a particular focus on the financing system and related aspects of provision.

Health Research Policy and Systems, 2013

Background This paper explores the implementation and sustenance of universal health coverage (UHC) in Costa Rica, discussing the development of a social security scheme that covered 5% of the population in 1940, to one that finances and provides comprehensive healthcare to the whole population today. The scheme is financed by mandatory, tri-partite social insurance contributions complemented by tax funding to cover the poor. Methods The analysis takes a historical perspective and explores the policy process including the key actors and their relative influence in decision-making. Data were collected using qualitative research instruments, including a review of literature, institutional and other documents, and in-depth interviews with key informants. Results Key lessons to be learned are: i) population health was high on the political agenda in Costa Rica, in particular before the 1980s when UHC was enacted and the transfer of hospitals to the social security institution took place...

RePEc: Research Papers in Economics, 2015

Over the past quarter century, the countries of Latin America and the Caribbean (LAC) have experienced rising incomes, with corresponding reductions in levels of poverty. At the same time, countries have achieved improvements in health and well-being for all segments of the population: average life expectancy has risen significantly, more children live to see their first and fifth birthdays, and fewer mothers are dying from complications of childbirth. Nonetheless, health inequities persist between and within countries, and some health outcomes are still unacceptable, challenging health systems to develop innovative approaches that will improve responsiveness and address people's changing needs. Universal health coverage (UHC) has been at the center of the global public health agenda in recent years. As one of the overarching goals of health systems, UHC provides countries a way forward to address unmet needs and health inequities. The World Bank has embraced UHC as part of its mission to eliminate absolute poverty by 2030 and to boost shared prosperity. The Pan American Health Organization (PAHO) in October 2014 adopted a regional Strategy for Universal Access to Health and Universal Health Coverage, which expresses the commitment of PAHO Member States to strengthen health systems, expand access to comprehensive quality health services, provide financial protection, and adopt integrated, comprehensive policies to address the social determinants of health and health inequities. For the past two years, the World Bank and PAHO have engaged in a collaborative effort to examine policies and initiatives in LAC aimed at achieving UHC. This report is one product of that collaboration. It includes contributions from professionals from both institutions and it has received the support of researchers from several countries in the region. The report provides insight on different approaches and progress being made by selected countries over the past quarter century to increase population coverage, services covered, and financial protection, with a special focus on reductions in health inequities. The report shows that countries have made meaningful progress toward UHC, with increases in population coverage and access to health services, a rise in public spending on health, and a decline in out-of-pocket payments, which can result in catastrophic spending and impoverishment for many households. Expanded health services, including preventive, curative, and specialized services, have also been observed in most countries, and service utilization has become less

International Journal of Health Services, 2011

1998

Medical Anthropology Quarterly, 1989

This article criticizes the concept of ''political will" by analyzing Costa Rica's experience with community participation in health between I973 and 1985. Despite a long-standing state commitment to social welfare programs, Costa Rica has been unable to achieve active, sustained participation in the government's rural health programs, partly because of partisan conflicts over implementation. It is unlikely that ' 'political will" can succeed in countries where the state's commitment to social welfare is less obvious than in stable, democratic Costa Rica. This article identifes three problems with the concept of "political will" : (1) by focusing on individual countries, it shifts attention from the international health agencies that so ofen determine poor countries' health policies; (2) it implies that states are monolithic entities, comprised of unifed coalitions, rather than competing groups involved in a constant struggle over policy; and (3) it diverts the analytic gaze from global inequalities and relations of international dependency that contribute to poverty and ill health. Rather than blaming poor countries for their supposed "lack of political will,' ' international health organizations should examine what factors led them to rescind their commitment to community participation in health.

2015

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CEPAL Review, 2001