One Gringo Family's Experience with Universal Health Care in Costa Rica


Seguro Social Logo for Costa Rica
Logo of Costa Rica's Social Security
Everyone, Ticos and Gringos alike, love to kick the Caja, especially when it's down, which it is pretty much all the time. Caja Costarricense de Seguro Social (CCSS) is the Costa Rican government's universal health care system implemented after the 1948 civil war, which resulted in the abolition of the Costa Rican Army and the government refocusing its resources towards social programs.

No question about it, there is plenty to dislike about the system. In general, it's underfunded, understaffed, overcrowded, and slower than a sleeping sloth. Worse, the resources that it does have are scattered about the country unevenly. While in Cañas there is a state-of-the-art clinic, here in Pérez Zeledón the hospital is an awkward maze architecturally and in terms of process. The only thing holding up the building appears to be the umpteen layers of paint on the walls.

That said, the Caja does provide access to health care for millions here, health care that citizens could simply not afford otherwise. Monthly premiums are minuscule (update: were miniscule, now 13% of income for new residents) and cover literally everything, all clinic or hospital visits, doctor appointments, procedures, exams, surgery, and prescriptions. Though there are always horror stories, there seem to be an equal number of stories about folks who have accessed the system, gotten superb care, and walked away without a bill. Obviously, one's mileage can and does vary.

This post, however, is not about tearing down the Caja, nor is it a step-by-step guide to how to use it. It's just the story of our most recent access to this system when Tamara was seeking treatment for her ovarian tumor (update: she's cancer free now, by the way, but no thanks to Caja). Our story is atypical, because we had some inside help, so keep that in mind. Take a grain of salt, and mix it in with whatever else you've read or heard about Costa Rica's government-run health care during this narrative.
Woman on hospital gurney
Woman on gurney in Costa Rica hospital
I've lost track of how long ago it was that Tamara's tumor was detected via ultra-sound at her otherwise routine visit to a private gynecologist here. It was several weeks before she got treatment. After the gynecological exam we visited a private imaging doctor, educated in Colombia. She has the latest and greatest equipment and runs the machine herself.

The mass in Tamara's ovary was obvious, but we needed a crisper image in order to define it further. First, we contacted our family doctor, who is a friend of ours and is also one of the rotating directors at the Caja hospital, to see if we could get her in the hospital for a CAT scan or possibly a biopsy. This is the point, though, where Caja's ingrained inertia started slowing things down. 

With our doctor's help, we skipped the usual several hours of waiting in line and Tamara was admitted to the gynecology ward within about two hours. The ward is on the top floor adjacent to the maternity ward. The place is bright, airy, clean, and the staff are friendly and helpful, but no one speaks English. Visitors from First World countries, however, would probably not like the "seating arrangement" of two large rooms with eight beds without partitions in each. On this visit ,the rooms were full, so Tamara and another  patient had to take beds in the hallway. She received a bed in one of the rooms the following day.

This first day, no doctor came to see Tamara. There were nurses who took some medical history, but that was it. Doctors were around, but she didn't get a turn. The next day, a doctor came to assess her condition and provide some options. Despite the involvement of only one ovary, their recommendation was a full hysterectomy, which we were against.

Take note of that recommendation because you will begin to detect an odd pattern as her "treatment" progressed. No decision was made that day, but late morning on her third day in the hospital I came in and together we consulted with the two doctors on duty. 

In order for Tamara to avoid a full hysterectomy, she would have to undergo four separate exams to get approval for removal of just her left ovary: a colonoscopy, gastroscopy, CAT scan, and pielogramma (a detailed X-ray with contrast medium of her entire urinary system). They could do those tests either in this hospital or one in San José.

Here's the catch, however: she would have to remain hospitalized and it would likely be three weeks before they could complete all exams.

Whoa! Tamara was already going out of her mind with boredom after two and a half days, so you can imagine her reluctance to spend at least three more weeks in that bed with no certain date for getting out.

The rationale for these exams was to ensure that there weren't any other tumors in her body, which might indicate that the ovarian tumor was metastasized cancer. In other words, they wanted to cover their butts for what is apparently a "special request".
These exams were not required if she opted for a full hysterectomy.

The alternative, which we took, was to acquire the exams outside the hospital in private clinics then return to the hospital for surgery, which is the most expensive component of the treatment anyway. So, Tamara checked out and we began Phase Two, of getting those exams.


3 comments:

  1. Wishing you both the very best!!

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  2. best for you peolep thanks ok
    stanmacloo@gmail.com

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  3. This comment has been removed by a blog administrator.

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Thanks so much for your comment! - Casey

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