Many countries have government-sponsored health care. Costa Rica is among them. The two political parties in the U.S. are battling over whether or not to retain what is known as Obamacare, which will include millions more people under the current plan and erase some of the contingencies insurance companies can use to limit their coverage. The cost, some say, will be enormous.
Costa Rica has nearly universal health care sponsored by the government. It is colloquially called “the Caja.” Early in its history costs were covered by members’ monthly payments, based upon their incomes, and the money saved as a result of not having to support a military. As everywhere, costs have gone up. I have been a member of the Caja ever since I became a resident. Now it is mandatory for all legal foreign residents to join the Caja. It still has financial problems as well as the problems associated with all hospitals, doctors and medical care in general.
First let me quote Dr. Marty Makary, who has researched and written much on health care safety and shortcomings in the United States. His latest book is, “Unaccountable.” He cautions, “Human doctors are doing human things.” And humans make mistakes and are not always pure of heart. Hospitals are built and managed by humans. The same is true in Costa Rica.
The Caja contains hospitals, clinics and ebais. They constitute the three levels of care, from the EBAIS, which furnishes the basic attention and preventive care. The name is an acronym based on the Spanish title. An installation also has doctors who write prescriptions. If there is a generic form of the medication you will probably get it. Clinics are equipped with more sophisticated equipment, like x-rays and blood test facilities. Hospitals handle complete medical attention. Operations are performed, and complicated tests are administered. Every hospital has an emergency room. Some local clinics are terrific, others, not so much. Two of my favorites have been the one in Pavas and the one that services Barrio Lujan and surrounding neighborhoods.
There are three Caja hospitals in the city of San José. I have spent time in all of them. I would prefer not to return to San Juan de Dios, located at the east end of Paseo Colon in downtown San José. It is always crowded, and the distances between sections are so far that it seems to me that if you can make the trek you don’t need to be in the hospital in the first place. The halls of the emergency section are lined with people waiting interminably. All emergency rooms are overcrowded, but once an authority tells the patients’ relatives or friends to leave, it empties noticeably.
It was at San Juan de Dios that I experienced my first cold shower during my only inhospitable stay. I found it torture, but the Ticas, also showering, assured me it was healthy. There were hot showers at both hospitals Mexico and Calderón Guardia.
If you are lucky, your private doctor also works for the Caja. After paying for a private visit, he or she can arrange for tests and even a hospital stay at a Caja hospital, and even an operation. Prescriptions written can be picked up at a Caja pharmacy. The catch is that you may have to wait for weeks, unless your doctor says it is an emergency or urgent, whereas at a private hospital it would be done more quickly. The good news is (if you are also a member of the Caja, of course), is that everything is free and without having to fill out a single insurance claim or wrangle with an insurance company over what they will cover. Having to do those can make you sick. And no matter what your age or previous health conditions, you will be covered and taken care of as long as your premium is current.
As for the quality of care, my experience has been that it is equal, and sometimes superior to the care I have received at the local private hospitals. I have expat friends who have learned far more readily than I how to manage the system and get everything from eyeglasses to dental work and physical therapy through the Caja without finding themselves overwhelmed.
From what I understand, the Caja is having some severe financial problems, due to . . . well, to human beings being human, which means not only corruption and greed, but to people avoiding their responsibility to pay their fair share. These systems do not work unless everyone who can benefit contributes.
For a clear and complete précis of how the Caja operates outside San Jose, I recommend the Web site containing “The EBAIS – Where Healthcare Starts,” by Paul Yeatman.