An account of years of positive government health care

by crv.staff
31.10.09
6:04 PM UTC

Filed in Costa Rica, Costa Rica Living

By Jo Stuart

Originally published in: AM Costarica

While the health care/medical insurance debate rages in the U.S., most of the rest of the civilized world has long ago found its own solution to the problem. Costa Rica is among them, and its answer has been government sponsored universal health care insurance.

There is also private insurance available through the Instituto Nacional de Seguros, a government sponsored monopoly known as INS. The government recently opened competition so soon there may be other companies for people to turn to.

My understanding is that INS pays between 80 and 90 percent of medical costs, but the INS patient must pay up front, fill out paper work in order to get reimbursed. Reimbursement may take months, and if you have charged the amount on your credit card, you are stuck with the interest. There are different types of coverage, I am told. This information is from a friend who has this insurance. I know of at least three private hospitals that cater to people with private insurance.

When I joined the Caja I was assigned to a hospital and clinic in my area. But as a patient I was sent to a different hospital if they had some more expertise or a doctor there that could help. Some doctors work at both private and Caja hospitals.

Every Costa Rican is supposed to join the Caja Costarricense de Seguro Social and soon, by law, new residents must also join. I joined as soon as I became a pensionada. I believe that what you pay is based upon your income. Most Costa Ricans pay via a deduction from their paychecks. My monthly payments have gone up very little over the years. I then had to go to my assigned clinic and sign up to get a card. No questions were asked about preconditions. My coverage was immediate.

At the same time that I enrolled in the Caja as an asegurado voluntario, I applied for a gold card (ciudadano de oro), which is available to residents and citizens over 65. This is the card I have referred to that enables me to ride the buses free.

I used to go once a month to a designated office in the Caja building on Avenida 2 to pick up a supply of tickets to ride. New residents’ cédulas now are made of plastic and most buses have machines that register your card (which you have given to the driver so he can put it in the machine). It is a good idea to have your gold card ready in case the bus driver asks.
Most banks have special windows that cater to seniors, pregnant women and those disabled. You can get in that line, or you can show your gold card to the bank guard and he will put you at the front of the regular line. I find this sometimes difficult to do and it doesn’t hurt to thank the people behind you as you head for the newly available window.

Even the Caja hospitals have special lines for seniors, and at my clinic, if I call the afternoon before I can get an appointment with the doctor the next day. Otherwise the lines can be long. But if you have a real emergency and call 911, you will get an ambulance promptly and it will deliver you to the emergency room of the government or private hospital you ask for. The ambulance is free. And once you are a member of the Caja and pay your monthly premium, you don’t get another bill — even for prescriptions the Caja pharmacies carry.

All of the above information is based upon my experience. It has been a while since I have visited the senior section of the Caja building, so procedures (tramites) may have changed.

I recently read that an 85-year-old man in the States had his pacemaker installed. According to the writer, it cost $70,000. Not long ago I had to have my pacemaker replaced. It was originally installed in the U.S. where I had problems with it, which put me in emergency three times. At the Caja I was allowed to choose the pacemaker brand, and it was replaced free of charge . . . so far so good.

The Caja also covers dentists and eye doctors, but I have not taken advantage of either. In spite of this governmental health coverage, private hospitals and doctors are doing very well. A patient who does not want to wait for attention at a free clinic or hospital can take advantage of private doctors, most of whom, compared to the U.S. are very reasonable.

People in Costa Rica differ in their opinions about the government managed medical care in Costa Rica. Over the years, I feel I have received as good care as I did in the States at a fraction of the cost.

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