Evolution of Bioethics in Costa Rica: A Recent History

Abstract

One of the most important achievements of the small Central American country of Costa Rica is its health care system, considered one of the best in Latin America, making its explanation necessary to understanding Costa Rican bioethics. The so-called Costa Rican health care sector, constituted by the Health Department, the Costa Rican Social Security Agency, the National Security Institute, the Costa Rican Institute of Aqueducts and Sewerages, the universities, and private health services, has managed to attain levels of health care comparable to those of industrialized countries, which has distinguished Costa Rica from the other Latin American countries. The Costa Rican Social Security Agency (CCSS-Caja Costarricense de Seguro Social), which was established on November 1, 1941, is a fundamental component of this system. The CCSS functions as an autonomous institution and its philosophy is based on the principles of solidarity, unity, universality, equality, and obligation. Since its creation, the CCSS has been the country’s primary health services supplier and has provided coverage for about 87% of the country’s population, including both Costa Ricans and foreigners. It also has more than 40,000 employees distributed among 2,695 welfare centers located throughout the country. Its assistance system is divided into three levels, which are shown in Fig. 10.1. With a basic understanding of the Costa Rican health care system and its function and structure, one can now understand the beginnings of Costa Rican bioethics.