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Comparison of American Healthcare system to Costa Rican Healthcare system

Yesenia Becerra

Health 101: Overview Health Care Industry

Mrs. Barker

May 6, 2022
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Did you know that the United States in the year 2020 had almost 31 million people

uninsured with no healthcare coverage throughout the whole year? This statistic has blown the

mind of many, especially when the United States is regarded as one of the richest countries in the

world. How can it be that the United States is still behind in an effective healthcare system

compared to many other industrialized countries? Unfortunately the United States places almost

near last place compared to its westernized counterparts and it is expected to not change. The

United States needs to change its healthcare delivery method in order to deliver uniform

healthcare to all. For example, Costa Rica, this country is currently still considered to be a

developing third world country but this country has astonished the world by improving its

healthcare system by offering universal healthcare to its population and it has been cited as one

of the best in the world. This is why the United States needs to have a universal healthcare

delivery system in order to ensure a healthier population and lower health costs for all. This will

not only result in decreasing the health disparities between the rich and poor but will also

contribute in the long run to a healthier population which will help the future of healthcare costs.

The United States is considered to be one of the richest and best countries in the world.

Yet, their healthcare system is considered to be broken, complicated, and it desperately needs to

get worked on. The United States spends much more on healthcare costs than any other country

in the world. Even as a high-income country, the U.S. spends more per person on health than its

industrialized comparable countries and the population isn't as healthy as compared to the rest.

Other wealthy countries spend half on healthcare per person than the US, which spends about

$11,945 in 2020 per person. (Wager, Ortaliza, Cox, 2022) Costa Rica which is considered a third
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world country is and has been advancing in providing an effective healthcare delivery system to

its population. Costa Rica has a much lower capita rate in terms of healthcare costs per person.

As of 2019, the country’s per capita national health expenditures were to be $922 in US dollars.

(Knoema, n.d) This is much lower than the US and yet Costa Rica has a higher life expectancy

than the US. As of 2020, Costa Ricans have a life expectancy of 80 years old, while in the US,

life expectancy is 77 years old. ( World Bank, 2020) Health care costs in the US have been

increasing almost every year. These costs have increased by 9.7% from 2019 to 2020. (AMA,

2019) This is a huge problem because it makes it difficult for many Americans to receive the

healthcare they need. Many no longer proceed with their medical appointments due to the high

medical costs and the bills that continue to rise. Many Americans struggle to pay their medical

bills even if they have insurance. The reason for this is due to the fact of high deductibles and

other forms of cost that have built up causing a major effect in the lives of Americans. According

to the data from the Survey of Income and Program Participation, it was analyzed by researchers

that medical debt is higher with people who suffer from a disability than those who don’t.

According to this survey it states that the people in the United States owe at least about $195

billion in medical debt. (Rae, Claxton, Amen, Rager, Ortaliz, 2022) This is important because

this debt continues to increase as the cost of healthcare services increase. Especially with a

population that is growing older, it is important to implement a change in the US healthcare

system. Costa Rica has been providing healthcare coverage since the 1940s and it became a

country to offer universal healthcare coverage to everyone by 2010. (Columbia Public Health,

2019). They have had this system as well as social security providing healthcare to all. It is one

of the few countries in Latin America that offers almost complete universal coverage through the

public sector known as the Caja Costarricense de Seguro Social (CCSS), but they also offer some
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options through the private sector as well. (Columbia Public Health, 2019) Thanks to this

system, it offers 100% coverage for all medical procedures and prescription drugs, which is

amazing because it provides healthcare to many without facing financial burdens such as here in

the US.

In Costa Rica, their Universal healthcare system is funded publicly and has a network of

30 hospitals and 250 clinics. It is managed by Caja Costarricense de Seguro Social (CCSS). In

order to fund their Universal health care, residents and the public of Costa Rica must pay a small

monthly fee based on a percentage of their income. The higher they earn, a higher amount is

deducted. ( Pacific Prime, 2022) The CCSS is funded by 15% payroll taxes, as well as taxes

collected from certain goods such as luxury items, alcohol and soda. Thanks to this it has

provided free medical care to almost all of the population. Costa Rica also has community

healthcare workers that help aid in prevention for future health concerns. They are known as

Equipos Básicos de Atención Integral de Salud, or EBAIS in English translated to the

Comprehensive Basic Health Care Team program. These teams have become essential in

delivering healthcare to most of the country. They are assigned into teams and each team is in

charge of providing care to 1000 families. Just like community healthcare workers, they are

usually outside of a healthcare office setting and they go from home to home providing care to

the public. EBAIS consists of a physician, nurse, public health workers and they serve as the first

point of contact in delivering health care throughout Costa rica. Each team is assigned to a

specific region therefore delivering this care to everyone, including in rural communities. They

also have other assignments such as conducting surveys and registering data collection which

helps aid in what the community needs.(PHCPI, 2018) In Costa Rica, there is a wide range of

services as in the United States. There are many medical services that you seek in the US but at a
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much lower cost including specialists. For example, there are audiology, cardiology, geriatrics,

Neurosurgery, oncology, infectious disease and many other specialist services Due to the high

quality of healthcare in Costa Rica and the affordable healthcare prices, it has increased tourism

into this country and due to this, Costa Rica has become quite popular for medical tourism.

Under CCSS, services are not limited to just medical but dental and eye services are covered as

well. This program in Costa Rica is government run and it is mandatory for its residents to apply

for it. Under CCSS, there are three programs that are controlled by them, such as Maternity and

Illness insurance, the Disability, Old Age, and Death, and then the Non-contributive regime. (

Saenz, Bermudez, Saez, 2010) For the non-contributive, this is the group that does not pay the

monthly contribution that must be made due to poverty or having and suffering from a disability

that is interfering with the individual to work, therefore having no income to be able to pay for.

Compared to the US, the US currently has the Medicaid and Medicare program that has helped

many uninsured Americans get the coverage they need at an affordable price but unfortunately it

has been challenging and with its changing policies, it has become complicated. Unlike Costa

Rica that has a much more simpler and structured system, the US has a widely known program,

Medicaid and Medicare. Even though it has brought in beneficial elements to the US healthcare

system, it continues till this day to be complex and challenging. Not every healthcare official or

the public fully understand the complexity of Medicaid/Medicare. Medicaid has helped a lot in

being able to provide insurance to families and individuals with low income and older

populations who cannot afford private insurance, but it has become a challenging program. As

Medicaid continues to expand it has grown and grown in complexity which has raised questions

within the public since there are challenges being faced within the federal and state financial

responsibilities in financing this program. (Gold & Mittler, 2000) Unlike Costa Rica that has a
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much more governed health care system, the US has many other programs which contribute to its

healthcare complexity such as VA, and individual plans provided by different insurance plans in

the market.Due to this, it has increased disparities within the rich and poor because not every

healthcare office accepts certain insurances, making the disparity grow larger. Both Costa Rica

and the US have it somewhat similar in that the people who work contribute a certain amount to

insurance. For example, a certain percentage from tax payers is cut out in order to help fund

Medicaid and Medicare. With all this being said, having community healthcare workers has

helped Costa Rica in having better health outcomes than the previous years. I believe it is

something that here in the US we should implement much more strongly. This is why it is

important in the United States to bring up much more preventional measures to the public.

In Costa Rica, they do have challenges regarding their universal healthcare system and

primary health care delivery. Like any other country that practices the universal health care

delivery system, there are long wait times for certain medical procedures. Unfortunately many

times, individuals turn to the emergency room for these medical reasons and emergency

treatment costs are expensive. Just like in the US, Costa Rica is starting to experience an aging

population which contributes to many more healthcare needs and costs. Costa Rica is also going

through a growing number of non-communicable diseases within the population. For example,

obesity is rising within the teenage population just as in the United States. This is something that

Costa Rica has brought special attention and per CCSS Executive President Dr. Román Macaya ,

has noted the importance of caring for individuals in the primary and secondary care levels and

their ability to resolve issues before it turns into hospital level. (PHCPI, 2018) In comparison to

the United States health system, the US has a well trained healthcare workforce and secondary
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and tertiary institutions, including many health research programs. They offer lots of medical

services and have some of the best medical equipment compared to many other countries,

including Costa Rica. Yet, in American healthcare, unfortunately there are many disparities

between socioeconomic status, race, and unequal distribution among the country. All of these

reasons contribute to poor access to healthcare. In Costa Rica, there aren't health disparities as in

the US. In Costa Rica about 84% is covered by the CCSS program. Still to this day, racial and

ethnic disparities play a huge part in the US because a large number suffers from chronic disease

and premature death compared to the rates among whites in the US. ( Baciu A, Negussie Y,

Geller A, et al, 2017) The US has also been making progress in trying to reform its health

system by introducing the Affordable healthcare act that was implemented in 2010. It expanded

access to affordable insurance coverage and it has been working on reforming the healthcare

system by reducing costs and improving the quality of care that individuals receive. Hopefully in

the long run it brings in great results from the public as it is fairly new and researchers and

analysts need to see how this affects the American public and healthcare system.

With all these differences between the US and Costa Rican healthcare systems, it is

incredible that even though the US is larger, richer, and spends much more on healthcare than the

Costa Rican healthcare system, the US still falls below in its healthcare delivery system. The US

is far more advanced in medical technology and provides one of the best medical care compared

to other countries. Compared to Costa Rica, Costa Rica is improving its healthcare delivery

while the US is falling behind. Changes must be made in regards to the cost of medical services

and also in working hard towards reducing the disparities between all the different groups in the

US. regardless of Sex, race, ethnicicty, socoeconomic status, etc. This is something that still
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needs to be achieved in the US. The US has all the sources available but it needs the correct

leadership and teamwork in order to accomplish this goal. Without any one falling behind or

feeling they are losing money or receiving the end of the stick, hopefully in the future, the goal

of providing universal healthcare for all is achieved in the US. It may be hard, but with progress

and the cooperation of the public, state, and government, it can be achieved.
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References:

1. Shmerling, R. H. (2021, July 13). Is our healthcare system broken? Harvard Health.

https://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542

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2. COSTA RICA | Summary | Columbia Public Health. (n.d.).

Www.publichealth.columbia.edu.

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rica-summary#:~:text=Around%2030%25%20of%20Costa%20Rica

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0spending%20in%20the%20U.S.

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ta%20Rica%20boasts%20a%20universal

5. Del, M., Sáenz, R., Luis Bermúdez, J., & Acosta, M. (2010). Universal Coverage in a

Middle Income Country: Costa Rica. Retrieved May 5, 2022, from

https://mronline.org/wp-content/uploads/2021/02/CostaRicaNo11.pdf

6. Tallon, J. R. (1990). Medicaid: challenges and opportunities. Health Care Financing

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7. Gold, M., & Mittler, J. (2000). Medicaid’s Complex Goals: Challenges for Managed Care

and Behavioral Health. Health Care Financing Review, 22(2), 85–101.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194657/

8. Costa Rica: Universal health coverage and community-based health teams create

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https://improvingphc.org/promising-practices/costa-rica

Deliverable