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close this bookThe Nutrition and Health Transition of Democratic Costa Rica (International Nutrition Foundation for Developing Countries - INFDC, 1995, 228 pages)
close this folder2. Development of the social security institute
View the document(introductory text...)
View the documentBackground
View the documentSocial security in Costa Rica
View the documentThe extension of direct insurance
View the documentExtension of insurance to the family
View the documentThe financial crisis
View the documentThe constitutional amendment
View the documentToward universalization
View the documentDevelopment of human resources
View the documentThe integration
View the documentThe new health care models
View the documentFinal comments

Extension of insurance to the family

The growth in coverage of wage earners as well as the initiation of medical services to the beneficiaries made evident the need for coverage of their dependents as well. The board of directors listened to the requests for services, in particular those coming from the coffee plantations. Soon after the Ley Constitutiva de la Caja was approved, almost all the social protection organizations in the country explored the possibility of a closer relationship with the Social Security Institute in order to obtain financial support for the hospitals under their jurisdiction. Local interests, however, quickly stopped the initiatives from these organizations. The exception was in Turrialba, where distance and other factors had created a unique situation. The Municipal Council obviously with external advice, established a system to cover the populations of large farms. The system was funded through a wage tax (3% provided by the worker and 2% by the employer), to provide health care to the farm workers and their families. It included medicines, and financed the small local hospital. All this was achieved in 1944. The community requested the transfer of the William Allen Hospital in Turrialba and the inclusion of workers and their families for maternity as well as medical care. The Institute now experienced a paradox, since it now offered services beyond the Central Plateau and provided family medical coverage in a rural area. Both events were an exception to the traditional development followed by Social Security Institutions.

As a result of this precedent, the rural populations of the Central Plateau began to request service for their families as well. In 1955 the Board of Directors of the Council adopted the provision of medical services to dependents as a permanent policy. An analysis of the coverage (Table l) shows clearly thee the inclusion of family members resulted a rapid increase in the number of persons covered. By 1960, five years later, although there had been very little increase in the number of insured workers there were now an equal number of ocher family members covered. The total increase reflected well the coverage of the total population that increased from 12% to 15%.


FIGURE 1. Total Population, Economically Active Population (PEA), Illness and Maternity Insurance (SEM), and Old Age and Life Insurance (IVM) Costa Rica, 1950-1990

Source: Memoria Institutional 89-90