Costa Rican Health Care Overview- Costa Rica provides health care services for residents through a program similar to the social security program in the US. The Costa Rican equivalent is known as the CAJA but is really the CCSS, (Caja Costarricense de Seguro Social). There are approximately 30 public hospitals operating under the CAJA and about 250 public clinics located throughout the country. Clinics, known as EBAIS, can be found throughout the country and are the primary source of medical care in the countryside providing basic health care services. For more advanced care, patients of the CAJA are referred to the 5 major hospitals in San Jose. In 2009 there were 5 specialty national hospitals, 3 general national hospitals, 7 regional hospitals, 14 peripheral hospitals, and 10 major clinics serving as referral centers for primary care clinics. In Costa Rica, all residents are entitled to care through the public system and Costa Rica spends roughly 8% of GDP to pay for these services. Under the new Immigration laws of 2010 all expats must enroll and contribute to the CAJA system (about $75 - $455 per month per person, depending on age) and are eligible for low cost access to the national health care system, neighborhood clinics, hospitals and pharmacies. Your CAJA contribution will be based on the size of the pension you present as proof of foreign income when you apply for residency in Costa Rica.
Costa Rica Health Plan Summary:
- CAJA (CCSS) is offered to all residents (participation is required for immigrants)
Covers doctor’s visits, medications, examinations and hospitalization.
Pre-existing conditions are generally covered
Covers pre-existing conditions.
Covers all medications including dental and eyes.
Some reasons to consider this plan.
Have pre-existing health condition and do not qualify for INS insurance.
Take medication on a regular basis.
Have it as major medical in case of serious illness.
Monthly premiums cover all illnesses for the member and his immediate family for that month. The cost, for someone younger than 55 years old starts at about $150 per month; 55 years or older and also qualifying for as "pensionado" starts at $75 per month but is based on the ampount you declare as your pension that you used to qualify for residency as a retiree. If you declare a high pension, you might end up paying $300 or more per month...
- INS - The governmental insurance company.
Covers 80% of the cost of doctor’s visits, medications, examinations and hospitalization.
Individual chooses the doctor.
Does not cover any pre-existing medical condition.
Does not cover most dental or eye exams, treatments or glasses, preventive medical check-up, illness or disorders related to female reproductive organs during the first 12 months of coverage, or birth of a baby during the first 6 months of coverage.
- International Health Insurance Policy
The INS and other Insurance Providers offer an international insurance policy that covers your needs in Costa Rica and the rest of the world. These new medical policies cover medical expenses due to accident or sickness. Items covered include Hospitalization and ambulatory expense, maternity, prosthesis, organ transplants, air evacuation, repatriation of remains, funeral costs and a yearly check-up and eye test. The rates are higher but the coverage is still very reasonable, especially when compared to the US. Costs vary according to the carrier and a variety of carriers can be found using Google or other search engines
- Dental Insurance Plans - A variety of dental plans are available both through the INS as well as international carriers but dental care costs are considerably lower than in the US. Typical cost for a root canal is $200 or less, crowns $250 or less, fillings from $20 to $60 and dental implants typically cost about 30% of comparable prices in the US. Costa Rica's health tourism industry initially started with dental care.
- Elderly Care- Elderly care facilities are now appearing in Costa Rica with the primary market being immigrants and expats. There facilities are designed on US models and are considerably less expensive than US equivalents. Those unable to afford such care can hire live in domestic help often for a fraction of the cost of comparable care in the US or Canada. There are some elderly care facilities operated by the CAJA but they are generally in short supply. With high emphasis on family, most Costa Rican families keep their elderly parents at home.
The primary public hospitals of merit in the CAJA are:
Hospital Nacional de Ninos in San Jose - http://www.hnn.sa.cr/ A 250 bed facility located in San Jose was founded in 1845 and reputed to be the best children's hospital in Latin America. Pediatric specialties for urgent care and life threatening illness for children 12 and under.
Hospital San Juan de Dios in San Jose - http://www.hsjd.sa.cr/ A 600 bed facility specializing in intensive care, burn treatment, cardiac care and a good surgical unit. The hospital is located in a variety of "pensiones" that house different treatment facilities. It also has a good psychiatric center as well as an addiction treatment center.
Hospital Nacional Dr Max Peralta Jimenez in Cartago http://www.hmp.sa.cr/ Founded in 1922 this facility offers a complete suite of health services. Currently the hospital handles 633 beds but the physical condition of the hospital is in need of improvement. A modernization and expansion is currently underway.
Hospital Mexico - La Uruca - just off the General Canas Highway (the Pista) between the SJO airport and downtown San Jose. This facility is crowded and in need of a rehab but there are a large number of specialists and physicians located in the immediate area. There are a number of medical buildings surrounding the hospital that support the services of Hospital Mexico. It is reputed to offer decent care but wait times are often long and the hospital sometimes suffers from shortages of necessary equipment.
Hospital Rafael Ángel Calderón Guardia - San José - There are more than 600 beds in this facility and they often handle thousands of outpatients daily. The surgical theaters, cardiac care unit and the intensive care unit are well equipped. It is often difficult to find English speaking staff here however.
Private Health Care Options in Costa Rica
There is also an extensive private health care network in Costa Rica and private insurance is available for expats through the INS, the nationalized insurance agency in Costa Rica. The private health care system features a variety of hospitals and clinics of which I will discuss in detail below. The private health care network provides faster service and increased privacy. This network consists of a number of hospitals, most affiliated with US hospitals or Universities. The 3 primary hospitals of merit are:
CIMA Hospital, http://www.hospitalcima.com/ located in Escazu off the Circulavacion highway and the newest private hospital in Costa Rica and opened in February 2000. CIMA is affiliated with the Baylor University Medical Center in Dallas and managed by the International Hospital Corp of Dallas as well. CIMA is a full service hospital noted for the latest equipment available including a phenomenal coronary facility. Services also include MRI's and Ultrasounds, joint replacement, prenatal care, emergency and intensive care. CIMA is a beautiful hospital and rivals the best hospitals in North America. There is a 7 story building adjacent to the hospital housing over 100 specialists in nearly every medical specialty.
Clinica Bíblica http://www.clinicabiblica.com/esp/index.php located in downtown San José, is now affiliated with the Blue Cross-Blue Shield network. Clinica Biblica was founded in 1929 and has grown and prospered ever since. The hospital is affiliated with the prestigious Evergreen Hospital in Kirkland, Washington and Clinica Biblica and Evergreen have a teaching relationship allowing doctors of both facilities to train in either facility. Services include cancer care, a large surgical facility handling joint replacement and major surgeries, a coronary center, neonatal, orthopedic, dental including oral surgery and more. Clinica Biblica offers an extensive medical tourism program for expats.
Clínica Católica http://www.hospitallacatolica.com/ located in Guadalupe, a suburb of San José. Clinica Catolica supports emergency and intensive care, mental health, respitory, nutrition, audiology, infectious diseases and even has a hyperbaric chamber. Diagnostic services offered are extensive and there is a full lab and pharmacy on premise. The facility includes the Hotel Posado el Convento - a colonial style hotel that adjoins the hospital and offers recovery services for patients.
An extensive list of healthcare facilities, providers, physicians and specialists is maintained by the US Embassy in Costa Rica and that list can be found here
Medical Tourism in Costa Rica- Costa Rica has an extensive history in medical tourism. Back in 1948 Costa Rica introduced a nationalized health care system in Costa Rica that provides nearly free medical care for all residents of the country. In the past ten years or so, Costa Rica has emerged as a top destination for both eco-tourism and medical tourism attracting clients from both the US and Canada as well as other foreigners. Costa Rica provides high quality health care at a much lower cost than many other countries. the World Health Organization ranks quality of care much higher in Costa Rica than in the US. www.WHO.orgThe close proximity to both the US and Canada has led to a large increase in visitors from these counties seeking affordable health care services that are cost prohibitive in the US and Canada. The high cost of many procedures and the lack of health insurance due to the high cost continues to attract foreigners in search of affordable health care options. Dentistry is also in high demand in Costa Rica since the cost of procedures like root canals, crowns, bridges, veneers, dental implants and oral surgery are much lower. The close proximity to the US and Canada and the large selection of airlines providing flights to Costa Rica has kept both the cost and travel time low. Direct jet service from the US is now offered by nearly every major carrier and the health facilities in Costa Rica are now seeking new patients from these markets. American Airlines offers 5 daily flights from Miami as well as direct flights from New York and Dallas. Delta offers daily flights from Atlanta and Continental from Houston. US Air, United, Jet Blue, Spirit Airlines, Taca, Lacsa, Mexicana, Air Canada and others offer direct jet service from a variety of gateway cities in both the US and Canada. International health care facilities are rated by an organization known as the Joint Commission International http://www.jointcommissioninternational.org/ that rates and provides accreditation for hospitals worldwide.
It is interesting to note that life expectancy for men in Costa Rica is 77 years and for women is 79.8 years, longer than life expectancy in the US. A recent article in Healthaffairs Magazine ( http://content.healthaffairs.org/content/early/2010/10/07/hlthaff.2010.0073.full.pdf found that the US has slipped to 49h worldwide in regards to life expectancy while Costa Rica is number 37 worldwide. Costa Rica averages 1.32 doctors per 1,000 inhabitants while the US averages 2.3 per 1,000. http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people
Costa Rica healthcare Internet Resources:
Asociacion Costarricense de Hospitales - http://www.netsalud.sa.cr/ach/
Colegios de Medicos y Cirujanos de Costa Rica - http://www.medicos.sa.cr/web/
Costa Rica Caja Costarricense de Seguro Social (CCSS) - http://portal.ccss.sa.cr/portal/page/portal/Portal
Costa Rica Government Portal http://www.gobiernofacil.go.cr/e-gob/weblinks/index.aspx
Costa Rica, Ministerio de Salud - http://www.ministeriodesalud.go.cr
List of Major Hospitals and Clinics in Costa Rica Here
Those seeking coverage through the private health network in Costa Rica can either pay for services as they go or buy an insurance policy through the INS, http://portal.ins-cr.com/ or through an international insurance policy offering coverage in Costa Rica.
All health service specialties are available in both the private and public health care networks including:
- General Surgery
- Thoracic Surgery
- Plastic Surgery
- Maxillofacial Surgery
- Obesity Control
- Endodontic Therapy
- Gynecology and Obstetrics
- Infectious Disease
- Hyperbaric Medicine
- Internal Medicine
- General Dentistry
- Physical Therapy
- Orthopedics and Trauma
- Peripheral Vascular
- Addiction Therapy