More On Healthcare In Costa Rica

A few days ago, while Lance and I were sitting on our patio, we heard the bell ring at our patio gate. We were a bit taken aback having no idea who it might be. At the time, we were not expecting anybody.

Also, we could not see who was at the gate. Our patio wraps around two sides of the house and we were on the wrong side to see who was there. It could be anyone: a friend, a neighbour, a street vendor, somebody wanting a donation for whatever purpose, somebody wanting to "share" their religion or whoever.

Nevertheless, Lance was somehow motivated to get off his butt and see who was ringing the bell. What then unfolded says a lot about the health care system in Costa Rica.

The person at the gate, whom I shall call "Doctor N" in respect for his privacy, flashed his credentials and identified himself as a doctor affiliated with EBAIS which is a foundation of the universal health care system in Costa Rica. He then began talking to Lance in Spanish using words which quickly surpassed Lance's ability to understand (and would also have surpassed my ability).

Our fluency in Spanish is limited. When this kind of situation occurs, our normal reply is to say "Lo siento, mi español es malo" (I am sorry, my Spanish is bad) or "Lo siento, mi español es muy pobre" (I am sorry, my Spanish is very poor). When Lance said one or the other of these phrases, Doctor N immediately switched to very fluent English.

He explained that somebody nearby in our neighbourhood had come down with dengue fever. This is a potentially serious malady spread by mosquitos. He indicated that he and some colleagues had been tasked with visiting every household in the neighbourhood to determine first and foremost whether everybody including ourselves were OK, then to warn about the situation, and to advise to get rid of any areas around our households where water might collect and provide a breeding ground for the culprit mosquitos.

This was all taking some time and motivated me to get off my own butt, go to the gate, and see what Lance and Doctor N were talking about. I decided that my first task was to unlock and open the gate to create a more conversational atmosphere. Lance was asking questions and further discussion ensued.

Turned out that Doctor N is a U.S. citizen from Arizona. If I understood correctly, he is presently practicing as part of an intern program in Costa Rica. But his ultimate objective is to return to the U.S. or perhaps Canada and establish a general practice. In the case of the U.S., he indicated that the only prerequisite for admission to practice once he was done in Costa Rica would be to pass some sort of exam. He did not indicate what prerequisite might be required in the case of Canada. But it appears that the bar may be very low at the present time: see "How to immigrate to Canada as a doctor". This is definitely not to suggest that Doctor N is looking for a low bar.

Doctor N was very conscientious. Now in my presence, he repeated his question to Lance. Is everybody OK? I could not resist complaining about my gimpy left knee with the damaged tendon. He was happy to have a look at it and gave me the same advice and treatment suggestions as I am getting from my orthopaedic doctor. His colleagues standing at the top of the driveway began to shout that it was time to move on. A free consult! Plus, he was young and cute with great teeth.

Click here to read an article (in Spanish, unless you have a translator on your computer or other device) that further serves as a typical example of the Costa Rican health care system. On November 7, a specialized transport team left Costa Rica for Panama to airlift an elderly Costa Rican with a broken hip. On board were an emergency specialist doctor, a respiratory therapist and a nurse. I wonder if the Canadian health care system would airlift me from Costa Rica if I had a broken hip …. nah.
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Unique Health Care System in Costa Rica

In my blog post earlier this year regarding Covid-19 (March 15, 2021), the numbers indicated that Costa Rica was doing better than Canada and the United States. The focus was on mortality. If you caught Covid-19, what were your chances of survival compared to Canada or the United States? It appears that Costa Rica continues to do better.

As the table below indicates, this continues to be the case:

Back in March, I speculated that this might be because on average those who live in Costa Rica spend more time exposed to outside air than those who live in Canada or the United States. I did not clarify, but I had in mind that one or the other or both of central air conditioning and central heating is relatively common in both countries. This might not provide a particularly healthy environment for controlling the spread of the virus.

Now comes to light another possible reason why Costa Rica has been faring better. It has a unique health care system. Specifically, Costa Rica has a health care model which combines a tiered universal medicare system with an unrestricted private care system: see Atul Gawande, "Costa Ricans Live Longer Than Us. What’s the Secret?”, The New Yorker magazine, August 23, 2021.

While Canada has a universal medicare system, it is not tiered like that in Costa Rica. Moreover, Canada severely restricts the services which can be provided by private enterprise. In the United States, the private care system is essentially unrestricted as it is in Costa Rica. However, while the United States has a medicare system, it is restrictive and far from being universal. Neither Canada nor the United States has a health care system which reaches down to individual households in a proactive manner as described by Atul Gawande.

We have experienced the proactive approach in Costa Rica. Two examples: (1) as described in my blog post on March 19, 2021, Lance got a personal telephone call out of the blue from a doctor at our local EBAIS to schedule an appointment for our first of two Covid-19 shots. I might be wrong, but I doubt that any person in Canada or the United States ever got such a call from any health care authority. (2) shortly after moving to Grecia/Hacienda El Paseo in 2018 and signing up with our local EBAIS, we were surprisingly visited by two medics.

As the New Yorker magazine article indicates, these medics are referred to as “ATAP" (Asistente Técnico en Atención Primaria) - trained community health care workers. They wanted to give us flu shots which we respectfully declined because neither of us had ever had flu shots (or ever had the flu over a period of decades). They also gave us pills for intestinal parasites - very common in tropical countries.

They also inspected our property indoor and out for cleanliness, etc. Their only recommendation was that we get rid of an outdoor pool of water which could provide a breeding ground for some mosquitos that are responsible for dengue fever - a fever which is survivable but not pleasant. We got rid of the “pool”. The pool was a relatively small plastic, rectangular container on the ground filled with water (usually rain water). Various species of birds found the pool and relished the opportunity to take a bird bath. That’s why we kept it until advised by the medics not to do so.