Costa Rica’s health care beats ours

 Costa Rica spends less on health care as a percentage of income than we do. Its per-capita income is a sixth that of ours, and its per-capita health care costs are a fraction of ours. Nevertheless, their life expectancy is nearly 81 years, while ours peaked at just under 79 years in 2014 and has declined since then. For people between ages 15 and 60, the mortality rate in Costa Rica is 8.7 percent. Here, it’s 11.2 percent—a 30 percent difference. In Costa Rica, the average sixty-year-old survives another 24.2 years compared to 23.6 years in the U.S. Here’s why: Costa Rica has made public health central to the delivery of medical care. Individual health and public health are inseparable. Even in countries that have good universal health care, public health is an add-on, not central to health care. In Costa Rica, it’s been a priority for decades.

Here's how they do it: They set up community health care teams throughout the entire country. The teams consist of a physician, nurse, and community health worker. Every Costa Rican is assigned to one of the teams. The health care worker visits every household at least once a year. Children have regular pediatric visits starting from the first day of life. People with diabetes are enrolled in classes to learn about controlling their blood sugar. Everyone gets contacted about vaccination appointments. And so forth. It’s all free. The Ministry of Health also deals with community-wide concerns and undertook programs to deal with malnutrition, toxic hazards, running water, and other health-related issues.

In the U.S., according to Dr. Atul Gawande, our medical systems “seldom focus on any overarching outcome for the communities they serve. We doctors are reactive. We wait to see who arrives at our office and try to help out with their ‘chief complaint.’” We’ve got plenty to complain about.

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