Sunday, May 18, 2008

On healthcare in Costa Rica

On one of the forums I usually read, there was a big discussion about whether health care is a right or not, and whether or not the U.S. should have universal health care. Before I answer that, I want to tell you a little about my perspective on what health care is like in Costa Rica.

Costa Rica is ranked #36 on the WHO's ranking of world health systems. The U.S. is #37.

Here in Costa Rica, everyone has access to emergency medicine. Yes, they want you to pay for it and will ask you for either your social security information or your relatives, but failing to provide either will not get you ejected from a public emergency room. For other, non-life-threatening procedures, you will have to pay into the social security system and probably have to wait quite some time to either see a doctor or have the procedure done at a public hospital. Paying into social security is not difficult and is dependent on one's income. For example, esposo has social security insurance at work that also covers me and our son, but he pays into it from his paycheck each month. This allows us to go to any public hospital or clinic for anything, but like I said, I have not heard of anyone being turned away for an inability to pay.

Some anecdotal observations:
  1. Several years ago, when we were struggling to make ends meet, esposo fell and tore the meniscus in his knee. This required surgery, so he went to the hospital to which we were assigned (San Juan de Dios in San Jose), saw a doctor during regular hours at his practice outside of the hospital, and set up an appointment to have the surgery done. Admittedly, the surgery could not be done for quite a few months (six if I remember correctly), but when you have no other real option, what do you do. After the surgery, they put a cast on his entire leg (which I thought was not good medical practice, considering most doctors in the U.S. would put a removable brace on it, thus encouraging some movement and rehabilitation of the knee), and he could not get an appointment to have it removed until a month after it was supposed to actually be removed (I think it was supposed to be taken off at 8 weeks and the appointment was for 3 months later). We ended up taking a hacksaw to it and removing it at home.
  2. When son was about two years old, he fell off one of the bridges at the University for Peace park and into a dry (thankfully) creek bed, injuring his back and hitting his head. I was freaked out; he was screaming all the way from U Peace back to Ciudad Colon (which is a good 20 minute drive at the least). When I got there, I took him to the nearest public clinic, where they asked me for his information (was he Tico, did I have his i.d. number [no of course not because I'm never prepared!], etc.). Even though I couldn't give them all of the information they needed, and didn't have any money with me to pay, they took all the info they could and asked us to wait to see a doctor. After about half an hour (though it seemed longer), we were seen by a clinic physician, who checked our son over thoroughly and said that he looked fine, just to keep an eye on him and watch out for signs of concussion (he didn't have one, by the way). Cost: $0.
  3. When you have a kid, something is bound to happen. Like shutting your child's hand in a door. I was worried that his hand was broken, so we looked for a doctor in town (couldn't find one open after 5), called our own doc on his emergency line (who said he was probably ok but we might get an x-ray to be sure), and finally went to the private hospital CIMA in Escazu. Went to the ER, where he was seen by a doctor about 10 minutes after we arrived (do you think that would happen in the U.S.? I daresay probably not.). The doctor looked at his hand, felt the bones, and was pretty sure there were no broken bones, but suggested we have an x-ray done anyway. So we waited about another half hour to be taken up to the x-ray room, where son's hand was x-rayed, back down to the ER room to wait for the doctor to read the x-ray, and after being pronounced whole and healthy, out for ice cream. The total cost for this emergency room visit, including x-rays, at a private hospital was about $75. Yes, we could have gone to the public hospital for free, but the wait would have been much longer, and with a screaming toddler I just would rather go to CIMA.
  4. In fact, I'd rather go to CIMA any time I have a choice. It is a top-notch facility, and we've always been treated there much better than at any hospital I've been to in the U.S., and I've gotten better service and better care. CIMA is associated with Baylor University in Texas, and is considered one of the top hospitals in Latin America. So when I went to have a growth removed from my leg, CIMA was the only place I considered. My doctor is also at CIMA; she charged me $60 for the office visit (which was actually her charge for a whole OB-GYN workup, including a PAP and ultrasound). And it wasn't a five-minute, in-out visit; she took a good 15 minutes talking to me about my history, my family, my future plans for more children or not, etc. The exam itself took another 25 or so minutes; she was very careful and thorough, unlike my previous OB-GYN in the U.S. (as has been my experience with other doctors here in Costa Rica; I've never had an office visit under half an hour here). Anyway, she noticed a growth on my leg and asked me if I wanted to have it removed; I definitely did, so we set up an appointment to have me come into CIMA for the outpatient procedure the following week. I arrived, checked in, got wheeled up to the surgery room, and the whole thing was over in a couple of hours. Then I went back downstairs to recovery, where I have to say, the nicest nurse I've ever had put on the cable for me, brought me some pillows and blankets, brought me a cup of tea (tea! he brought me tea!), besides taking my vitals and pronouncing me ready to go (but only after he was sure I rested for at least half an hour). I spent all together most of a morning there, and afterwards felt pretty great and was never pressured to hurry up and leave. Total cost: less than $200, including my doctor's fees, anesthesiologist, and rental fees for the surgical room. The biopsy was another $50 (negative, thank you very much!). I think you can see why I would choose to pay the miniscule amount to have a procedure done at CIMA by a doctor I know rather than go through the public system for free and have to wait for a spot to open up at the hospital. Plus, I sort of feel like even though we pay for the public system, I'd rather not burden it any more than it already is when we have the ability to pay for private care.
You might be asking yourself why the relatively low cost of health care here as opposed to the U.S. I would think one of the reasons is that malpractice is quite limited here; you just are not going to get very much money (relatively speaking) from suing a doctor for malpractice, even if a suit is found in your favor. Maybe it's also a matter of economics; in order for doctors to stay in business, they have to charge what people can afford. So even though CIMA is the best in the country, and I would think charges the most, it still isn't much compared to the U.S. I would think it's quite underused, actually, as every time I've gone in the waiting room is half empty, unlike public hospitals where people are often crowded out of the doors and there are no available chairs in the waiting rooms. When we did the baby tour (before son was born and we decided on a home birth), I think there were maybe two patients in the entire patient ward that day.

So do I believe the U.S. should have universal health care? I believe everyone should have access to health care, regardless of their ability to pay. No child should die from an infected tooth, for example; no cancer patient should be denied treatment because of their lack of insurance. This is inhumane and simply wrong. Call me a socialist commie, I really don't care! Yes, so we do pay into Costa Rica's public health system even though I prefer not to use it if possible. Do I feel angry or bitter about this? Not at all. We've used the system in the past when we couldn't pay, and now that we can, one more low-income/no-income mom/child/husband/grandma can get treated for free when they need it. I'd rather have it this way, than the way the U.S. does it now, where you pay exorbitant rates for insurance that you may or may not get to keep if you loose your job, and which that doesn't necessarily cover every treatment or prescription you might need; where you're always one catastrophic event away from being bankrupt.



  1. do you remember the name of the ob/gyn you saw and how i could set up an appointment?
    thank you.

  2. Yes! She's fantastic and I highly recommend her. Dr. Sae-Hui Kim 2208-1210, or e-mail And thanks for reminding me that I need to make an appointment for a checkup! Oh and she speaks perfect English; even though my Spanish is pretty good, there are some times when I appreciate an English speaker, and having an English-speaking doctor is one of them!