The Health System in Costa Rica: Toward a National Health Service

Abstract

lion, in a land area of 51,000 square kilometers. It forms part of the Central American isthmus along with five 2 u other small nations which until recently were pejoraUc94e44XSA tively known as "banana republics." The term grossly misrepresents the realities of this small country's people. Costa Rica has a long, stable tradition of being a fimctional liberal democracy. The current illiteracy rate is under ten percent. The infant mortality rate in 1979 was 22.4 per thousand live births. Mean per-capita annual income in 1978 was $1,400. As in most of the region's countries, the economy is highly dependent, based mainly on the exportation of agricultural products, as, for example, coffee, bananas, and meat. The last decade was characterized by a rapid and sustained growth of the economy. As we will see later, the current economic crisis, along with the nation's large external debt, has had negative effects on the economic structure, and growth is slowing down. Nevertheless, during the seventies, one of the sectors in which development was greatest, and in which the State invested large resources, was the health system. For the last forty years, the development of the health sector in Costa Rica has been closely tied to the development of the State. The latter is highly centralized and intervenes strongly in many areas of the economy and basic services, to such a degree that the social and political structure of the country can best be described as that of an "underdeveloped welfare state." Health, along with education, is one of the fields in which a relatively egalitarian level ofdistribution and high standards have been achieved. In recent years the health system has evolved rapidly so that it is now close to being a National Health Service, with practically universal coverage.