It has taken almost four decades to develop a health care system
in Costa Rica that evolved from a welfare system, mixing charity and indirect
government sponsorship, to a national health care system, based on the
principles or social security.
Four decades ago the Ministry of Health and the Social
Protection Organizations administered the curative and preventive programs
within the framework of technical and financial limitations that were then
prevalent. The birch and development of the Social Security Institute was the
starting point for a series of changes that have modified completely the
incidence and type of diseases as well as the levels of health and wellbeing of
In a sense, Costa Rica has followed the health care path of the
more socioeconomically advanced nations. The latter shifted from individual or
population systems to the social security model that took into account the
rights of citizens. These rights addressed universal access to health care and
well-being, and included adequate housing, education, nutrition, and clothing.
Initially, the systems based on social security were able to
protect their beneficiaries against a series of risks. However, this system
became selective and tended to concentrate benefits. They were selective because
they excluded segments of society that frequently were the most vulnerable.
Costa Rica launched its social security system covering the wage
earners from 1942 to 1955. Later, the wife, children under 12, and dependent
parents of the beneficiary also qualified for benefits. In addition, the
Institute took the unusual step of expanding into rural areas with the same
intensity as in urban regions.
With the removal of the upper wage limit in 1960, the Institute
expanded enormously the coverage of the Illness and Maternity program. In 1961,
Congress unanimously approved the modification of the National Constitution to
provide universal health care coverage and gave the Institute a maximum of 10
years to achieve this goal. In 1970, the Constitutional mandate began to take
effect. In the decade of the 1970s striking improvements in health statistics
were observed. As a result, at the time of the writing of this chapter, 84% of
the Costa Rican population is covered by health care, and the country has
achieved levels in health indicators that can only be found in industrialized
To date, the Costa Rican Social Security Institute offers, to
any country that wishes to adopt it, five major programs for the distribution of
· The Illness and
· Coverage of
occupational illnesses and accidents.
Disabilities, Aging, and Death program.
program of Family Benefits.
· Insurance for
unemployment and forced suspension of labor.
Costa Rica has strongly followed and consolidated the first four
benefits listed above. It is reasonable to expect that based on current
democratic and equitable social justice trends and on improvements in quality of
life in several countries, social security programs will become a social and
political objective as well as a product of development. Furthermore, within the
context of social rights, the situation of its citizens from now on should be
described as follows:
· Clean working environment
· Economic security
· Social development
· Unemployment subsidy
In this way, citizens will have a better chance to achieve
well-being in the