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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

Final comments

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 the population.

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 nations.

To date, the Costa Rican Social Security Institute offers, to any country that wishes to adopt it, five major programs for the distribution of social benefits:

· The Illness and Maternity initiative.
· Coverage of occupational illnesses and accidents.
· The Disabilities, Aging, and Death program.
· The 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:

· Improved health
· Clean working environment
· Economic security
· Social development
· Unemployment subsidy

In this way, citizens will have a better chance to achieve well-being in the future.