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Healthcare in Costa Rica – Good or Bad?

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Ask anyone: Costa Rica has some of the best healthcare in Latin America.

But, Latin America is one thing; the real question is – is Costa Rican healthcare good, by international standards?

The short answer: Yes! Healthcare in Costa Rica is excellent, period. In fact, it consistently ranks above U.S. healthcare [PDF] and that of other developed nations.

So, how does it work? Do you need to speak Spanish to get good care? How expensive is it?

We have the basics:

Costa Rican Healthcare: Public and Private Systems

The first thing you should know is that there are two health systems in Costa Rica: the government-run, universal healthcare system known as the la Caja Costarricense de Seguro Social, aka CCSS or la Caja (“la ka-ha”). Then, there’s the out-of-pocket (or via-insurance) private system, which consistently ranks as some of the best healthcare in the world.

You should know that the public and private systems are not mutually exclusive. Medicina mixta, or mixed medicine professionals work both privately and within the Caja network. We’ll discuss this more in depth below.

Medical costs, both public and private, are typically lower than in the United States. All Caja appointments, treatments, medications, etc. – absolutely everything covered by the Caja – is included in your monthly payment. There are no additional fees, ever. Private care starts around $40 per appointment and appointments often include extras. For example, a $60-$80 appointment with an OB/GYN often includes your 4D ultrasound.

There are almost a dozen major public hospitals in Costa Rica. Many, including the highly specialized Children’s Hospital, Women’s Hospital and Geriatric Hospital, are located in San José. There are also major hospitals in downtown Heredia, Alajuela, and Cartago, as well as large hospitals in all other provinces. For everyday maladies, Caja patients visit smaller EBAIS (“ay-bye-sss”), or clinics, which offer well care, sick care, and urgent care services.
What’s the Difference? Public vs. Private Healthcare in Costa Rica

The most quantifiable difference between public and private healthcare is the cost. As stated above, with the Caja, you pay one monthly fee and you’re done; there are never any extra costs. Caja payments are calculated as a percentage of monthly income, usually in the 10% to 11.5% range. Notably, only residents can affiliate with the public healthcare system. (In fact, as a resident you are required to pay into the Caja.)

With private healthcare, you pay for every appointment, test, procedure, and medicine. If this sounds intimidating, take heart: private healthcare is affordable here. In addition to $40-$60 office visits ($80-$100 for specialists), you can expect to pay about 25%-30% of what you’d pay in the U.S., even for major surgery. Additionally, private health insurance (typically, $150-$300/month, covering up to 80% of costs) and other cost-reducing programs (ex. Medismart) are available.

Both private and public healthcare are generally of high quality: up-to-date equipment, new hospitals and facilities, and constant improvements. However. You should know that the public Caja is chronically underfunded, which means that rural areas often don’t have the cutting-edge facilities and equipment of their metropolitan counterparts. Also, waits for appointments, especially with specialists, can be long.

And speaking of, both public and private network doctors offer your typical range of medical specialties, from general practitioner up through neurosurgery and orthopedic surgery. Unlike in the U.S., you can often get a private-network specialist appointment without a referral; in the public system, you will need a referral to see a Caja specialist.

Most major medical facilities are scattered around the Central Valley. However, a private and very well-regarded, full-service CIMA hospital opened a few years ago in Liberia, less than three hours to expat havens like Nosara and Tamarindo. CIMA Guanacaste joins the Guanacaste branch of Clínica Biblíca, another top-tier private hospital.

You Should Know: Pharmacies and Medicina Mixta

No healthcare in Costa Rica article would be complete without a brief note on farmacias (“far-mah-see-ah-sss”) and medicina mixta (mentioned above):

By law, there is always a doctor on call at Costa Rica’s farmacias, or pharmacies. In practical terms, this means that for minor issues – think, a sore throat or infected finger – you can often bypass the doctor’s appointment and head directly to your friendly neighborhood pharmacy doctor, who can diagnose everyday issues and prescribe medicines. No charge, except what you pay for your meds.

Additionally, many Costa Ricans and expats take advantage of medicina mixta, which allows you the ease of private medicine with the cost savings of the Caja. Here’s how it works: You make an appointment with a private doctor who offers medicina mixta (literally, mixed medicine with the Caja). You pay your $40-$60 appointment, but your doctor then writes your prescriptions through the Caja (= no cost, since you already pay into the system), or escalates your complaint to a Caja specialist. It’s faster than Caja-only and cheaper than private-only.

So, there you have it – the basics of Costa Rican healthcare, from public to private.

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