Costa Rica has a long history of investing in social health protection. Article 73 of the Political Constitution of 1949 provides the basis for social health protection in Costa Rica. The Costa Rican Social Security Fund (CCSS) manages two regimes, one for health and the other for pensions.
The Ministry of Health of Costa Rica regulates health service providers in the country. In accordance with the Reglamento del Seguro de Salud de la Caja Costarricense de Seguro Social (health insurance regulations), the CCSS offers a range of health coverage through which salaried individuals, self-employed workers, pensioners, voluntary contributors, and their dependent family members can partake. The state also provides coverage for individuals (and their families) living in poverty who lack insurance.
Contribution-based Financing for Social Security
The CCSS is funded by contributions from employers, workers and the state.[1] In the case of salaried individuals, contributions total 15% of payroll, comprising a 9.25% contribution from employers, 5.5% from workers, and 0.25% from the state. National budget (taxes and loans) finances individuals covered by the state for health.[2]
Domestic general government health expenditure (GGHE-D) represented 5.3% of GDP in 2021, and accounted for 25.4% of general government expenditure (GGE). Out-of-pocket health spending constituted 20.7% of current health expenditure in 2021, down from 32.8% in 2005.[3] The universal health coverage service coverage index stood at 81.1% in 2021.[4]
Main challenges and ways forward
Despite a robust health system, Costa Rica faces challenges related to the increasing demand for health services (driven by an aging population) and the unequal distribution of health resources between urban and rural areas. Rising prices for treatments and medicines also represent an additional financial cost.[5]
Regarding innovative solutions for greater efficiency, the CCSS has implemented one of the most widely distributed and comprehensive electronic health records in Latin America.[6] Its distribution covers the entire CCSS system, from community to third level of care. It includes users’ medical and clinical histories and also contains vital, individual information for improving people’s health, such as social determinants. A range of options have been suggested to increase fiscal space for health (including innovative financing among others) as well as improvements in management and execution of existing budgets.
References
[1] Organización Mundial de la Salud, Costa Rica, Estrategia de Cooperación
[2] José Francisco Pacheco Jiménez, Rebeca Alvarado-Prado, Financiamiento del Sistema de Salud en Costa Rica, Economía y Finanzas, Mayo 2022
[3] World Health Organisation, Global Health Expenditure Database, Health Expenditure Profile (choose country)
[4] World Health Organisation, Health Financing and Economics, WHO Health Financing Dashboard (choose country)
[5] Claudio Arturo Arce Ramírez, Financiamiento y cobertura del Seguro de Salud en Costa Rica: desafíos de un modelo exitoso, Gestión en Salud y Seguridad
[6] Ana Lucia Rosado Valenzuela, Ashley Sheffel, Ana Maria Lara Salinas, Micaela Mussini, Laura Di Giorgio, Expansion of the Coverage of the Single Digital Health Record (EDUS) in the PHC system in Costa Rica, Knowledge Brief, August 2023
