La Caja, our beloved public health and welfare system, is in the sights of many individuals and organizations -and not just in Costa Rica, but also around the world. La Caja is not in the best state in terms of financial solvency, and this comes at a time when the Tico population is showing clear signs of aging and a decreased birthrate.
Several international news and research organizations have taken an interest in the future of La Caja, probably because whatever happens to it might serve as a sign of things to come for social health care systems in other countries. La Caja has been lauded for the level of service it provides in a country with an annual Gross Domestic Product (GDP) of less than $10,000 per Tico.
Costa Rica’s social health care system has been the subject of recent scrutiny in the Seattle Post-Intelligencer, where La Caja was compared to the United States health care system. Respected British medical journal The Lancet recently published a comprehensive article about factors affecting our public health care system and how La Caja is dealing with them. The Costa Rica Star has also written on the matter, particularly about planned cuts and an editorial piece by James Black Marshall, PhD, titled Needed: Immediate Changes in the Caja de Seguro Social.
Mary Boland’s First-Person Account
One of the most interesting recent articles on La Caja coming from the international press appears on the Post Independent of Glenwood Springs in Colorado. That article was written by Mary Boland, who is described as a retired teacher and journalist, and a proud grandmother.
Mary Boland told the story of her husband’s stay at St. Mary’s hospital in Grand Junction, CO, and her own stay at our very own Rafael Angel Calderon Guardia hospital in Barrio Amon, San Jose. Mary Boland’s husband sadly had to go through a gastroenterology procedure and multiple blood transfusions. His stay at St. Mary’s lasted three days, and the hospital bill came up to $20,000, not including the bill for anesthesiology and gastroenterology services.
Weeks later, Mary Boland was in Costa Rica and sadly contracted pneumonia. She visited the Intensive Care Unit twice, and was subject to the battery of diagnostics that doctors at La Caja are known to order, ultrasounds, x-rays, etc. The bill came up to $7,000, all-inclusive.
This is how Mary Boland described her inpatient stay at the Calderon Guardia hospital:
Every ward had a central nursing station, and both interns and residents were constantly present, as were many nursing assistants. If or when anyone took a turn for the worse, doctors and nurses were immediately at the bedside and, as I experienced, removal to intensive care was also immediate. Senior teaching physicians circulated frequently, examining patients, adjusting their care, and putting the younger doctors through intense examination.
Every ward was scrupulously clean, patients were showered and changed every day, as was their bed linen. I found the food terrible, but my fellow patients didn’t seem to mind it too much.
She then posits the crux of her comparison argument between La Caja and the American healthcare system:
Costa Ricans have a GDP of about $9,000 per capita, and they are spending about 9 percent of that for this health care. Outcomes are as good as those of affluent Organization for Economic Cooperation and Development (OECD) countries. In fact, Costa Ricans’ life expectancy of 78.7 years is higher than ours in the U.S.
We [the United States taxpayers] are spending almost 18 percent of our GDP on health care, and we are the only major advanced society without a system for providing universal coverage. The World Health Organization ranks the overall performance of our health care system 37th, not first. This obviously contradicts the oft-repeated claim of the right that we have the best health care in the world.
It is always refreshing to get the insight of foreigners into matters of great importance to us, such as La Caja. Mary Boland’s comments help us to remember that our socialized health care system needs whatever little help we can provide, from payroll contributions to doing the best we can to stay healthy and avoid repeated visits to the EBAIS, clinics and hospitals.