Copyright January 2014, by Tim Woodruff
A Choice Between Public and Private Health Care
When it comes to health care, Costa Rica looks pretty robust: last year the World Heatlh Organization ranked its medical system 36th in the world, out of 190 countries. Costa Rica did way better than its closest neighbors — Panama at a dismal 95th, and Nicaragua at 71st – and even bested, for example, the US, New Zealand, and Cuba. One reason is the choice between the public and private systems.
In many cases, folks who have insurance or can afford to pay cash, opt for private care. It’s fast, efficient, and by all accounts, it offers top quality treatment. In contrast, the “free” public option is slower and less convenient. Its chief advantages are a) once you are covered it’s totally free, besides the very low monthly premiums, and b) it treats all conditions, including pre-existing. It can also be the best choice for emergencies, as well as certain procedures like complex childbirths, etc.; and, finally, it has a state of the art children’s hospital.
The major differences between the private and public options are outlined below. The rest of this article explains the approximate costs of health care, including insurance, in Costa Rica, and outlines the different available choices.
Note: US Medicare generally does not work in foreign countries, except to cover unexpected emergencies while traveling.
The Public Option
All foreigners in Costa Rica who receive permanent residency status (which requires living here at least six months per year), must sign up for “La Caja.” This refers to the CCSS, or social security system — a key part of the country’s essential fabric. La Caja guarantees every citizen and resident free and theoretically unlimited health care, regardless of pre-existing conditions, so long as they or a spouse or parent are registered under the system, as is required for all workers in the country. The monthly cost is relatively inexpensive, based as it is on a percentage of your stated income. For example, to cover myself, my wife, and my two children, we pay about $80 per month.
Even for foreigners or locals with good private insurance (or oodles of money), the public option can be especially useful in the event of an emergency, like an accident, or some acute condition, like appendicitis, heart attack, snakebite, etc. Under such circumstances, the care in the main public hospitals in San Jose is as good as you would get in a US hospital. And by using the public option you avoid either paying the costs directly out of pocket, and/or triggering your private insurance’s deductible, both of which can be pretty high these days. This assumes you have signed on with La Caja, as outlined above; if you do not have a Caja policy, then going to a public hospital would cost about the same as going to one of the private ones.
The problem for most foreigners is that the level of managed care within the public system is pretty basic, with long waits to see specialists like oncologists and cardiologists. The only way to get an initial appointment is through the national network of free outpatient clinics, called Ebais’s. For example, one of my workers (now retired) came to me recently complaining of chest pains, but said that the earliest appointment his Ebais could give him was in 2015. Evidently, the G.P. at the Ebais had decided that the man’s condition was mild. Since, for some reason, the fellow hardly felt reassured, we paid for him to see a specialist. As you would expect, in this kind of situation, everybody who can afford it pays to see a private doctor (BTW, the thorough examination by the cardiologist, including EKG and initial diagnosis, came to $80).
However, as noted above, in certain situations, like emergencies , the public option has its strengths. A quick anecdote: my son, Jack, now 5 years old, was born a “preemie” in Hospital Mexico, a public hospital under the auspices of La Caja. When we had earlier considered a private hospital, we discovered that my wife’s private insurance policy had a very low payout limit for childbirths. But we also found out that the same doctors practiced at both public and private, and that the neo-natal equipment in the state-run children’s hospital was the best in Central America.
So we went with the public option. It helped that my Costa Rican wife was familiar with the system. Although she was in a room with ten other women, and the bathrooms were not exactly five star, she received top of the line care through what turned out to be a very dicey medical situation. Thankfully, Little Jack came out fine, and in the end we saved about $70,000! Wow, is right!
The Private Option
Paying cash for private health care in Costa Rica tends to run about half to two-thirds less than in the US, Canada, or Europe. For example, a heart bypass costs about one-third of what you would pay in the USA, and the professionalism is comparable. Doctors here have acquired an excellent reputation for offering quality care and services to foreigners and locals alike, with elective surgeries, dermatology, and dentistry being among the most popular. Consequently, a medical tourism industry is burgeoning in Costa Rica.
The three JCI-accredited hospitals (meaning they are top of the line, state of the art, based on international standards) are CIMA, Clinica Biblica, and Clinica La Catolica. The patients that go to these hospitals are 20-40% foreign to Costa Rica, according to published statistics. They realize an average savings of 70% over the costs of similar procedures in North America or Europe, and in some cases up to 300%.
The same is generally true of the network of private clinics that dot the country. You can get decent and competent medical attention for most ordinary medical conditions, and/or quick transport to the bigger hospitals as needed.
Coverage and Costs of Public vs. Private Insurance Policies
As mentioned, the public option will likely cost you under $100 per month to insure your whole family for all conditions, including pre-existing. In addition, regarding the private system, there are a number of companies offering local or international health insurance policies to residents of Costa Rica. These tend to be substantially cheaper than similar policies offered to US residents.
The locally-based insurance covers you for approved doctors in the country, and usually has a 20% deductible. As a single man in my early 50’s, I was paying about $600 per year. This was with the government owned insurance company called INS, which until several years ago enjoyed a total monopoly on isurance in the country. Pre-existing conditions were rigorously screened for, and excluded.
Now you can get similar policies from a number of competing insurance companies, which tend to have cheaper prices than INS and offer more coverage.
In addition, you can get an international policy which will cover you in any country in the world, with a wide range of your choice of doctor and hospital. These policies, too, tend to be inexpensive. I am paying $800/year for a $1M international policy which lets me see most doctors in the US or Europe, as well as Costa Rica, Panama, etc. Because I have the mandatory CCSS coverage, I can choose which system to use, depending on the situation. Or to avoid the long lines or paperwork, I can pay cash for small stuff, like routine dermatologist visits, peridoic screenings, etc.
Comparing the Public and Private Insurance Options
1) Public Option: CCSS – National Social Security System
Coverage includes 100% of the following:
- Doctor’s visits, all medications, all examinations and hospitalization
- All (non-elective) surgeries
- All rehabilitation, whether post-op or otherwise
- Full medications including dental and eye treatment.
2) Private Option: INS, or Competing Insurance Company
Coverage includes 80% of the following:
- Doctor’s visits, all medications, examinations and hospitalization
- Patient can choose the specialist.
- Pre-existing conditions
– Dental or eye exams, or preventive medical check-up
– Illnesses associated with female reproductive organs during the first 12 months of coverage
– Childbirth during the first 6 months of coverage.
The Pharmacies Here Are Still Cheaper For Certain Meds
It’s still true today that many medcines are substantially cheaper in Costa Rica than the US, even though the pharmacies appear small and over-stocked with personnel. A lot of our friends “tank up” on favorites when they come down for visits, citing the high prices back home. However, this applies mostly to prescription drugs. Many basic products sold in local pharmacies here are much more expensive, including sunblock, bandaids, body and facial creams, aspirin, ibuprofen, vitamins, shampoo, etc.
Costa Rica’s public and private health care systems combine to offer decent medical care to its citizens and residents, regardless of income. For those who can afford it, the private system is a very popular choice. However, the public option is much less expensive because it charges a low monthly fee for total coverage, with no deductibles or co-payments, regardless of pre-existing conditions. It is also a solid choice for emergencies and acute conditions, although the waits to see specialists can be very long.
In sum, Costa Rica offers a little health care to everyone. The proof is in the (banana) pudding: Costa Ricans have a longer projected life span than any other people (besides Canadians) in all the America’s. No wonder the population is consistently ranked among the “world’s happiest”!