{
  "title": "Costa Rica Prioritizes Public Health",
  "publication": "IMF News, March 9, 2022",
  "sourceUrl": "https://www.imf.org/en/news/articles/2022/03/09/cf-costa-rica-prioritizes-public-health",
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  "summary": "Editor’s note: This article first appeared in the most recent issue of Finance & Development. Pura vida, the “pure life.” It’s an expression you’ll often hear in Costa Rica.",
  "authors": [
    "Analisa Bala March"
  ],
  "publishDate": "2022-03-09",
  "sections": [
    {
      "heading": "Overview and context",
      "content": "- Article by Analisa Bala, March 9, 2022.\n- Highlights Costa Rica’s long-term emphasis on public health, social welfare, and well-being as factors underpinning high life satisfaction (\"pura vida\").\n- Notes Costa Rica’s ranking in the 2021 World Happiness Report: 16th happiest place on earth; aside from the Czech Republic, the only emerging market economy in the top 20."
    },
    {
      "heading": "Key health system features and outcomes",
      "content": "- Universal access:\n  - Costa Rica is one of the few countries in the region that offers universal health coverage.\n  - 100 percent of the population has access to electricity and a source of drinking water.\n- Historical investments and outcomes:\n  - In the 1970s, Costa Rica spent more on health as a proportion of GDP than some advanced economies, including the United Kingdom.\n  - By 1985, the nation’s life expectancy was the longest in Latin America and matched that of the United States.\n  - Child mortality: dropped from about 74 deaths per 1,000 in 1970 to 17 by 1989.\n- Primary health care model (EBAIS):\n  - Implemented in the 1990s, building on decades of rural and community health programs.\n  - Every Costa Rican is assigned to an equipo básico de atención integral en salud (EBAIS)—a local primary health care team of physicians, nurses, and community health workers.\n  - Health workers visit each household annually in their assigned area to assess needs; data are combined with electronic health records to set targets, track progress, and focus resources on higher-risk areas.\n  - EBAIS teams were first deployed to medically underserved rural areas before expanding to urban centers, enabling a robust information system on social determinants of health.\n- Measured impact:\n  - Life expectancy rose from 75 in 1990 to 80.\n  - Despite strong outcomes, Costa Rica spent less on health care as a percentage of GDP than the world average in 2017: 7.3 percent versus 10 percent."
    },
    {
      "heading": "Social and political foundations",
      "content": "- \"Social pact\":\n  - Costa Rica maintains a political culture where successive governments build incrementally on prior reforms: “Regardless of the government that comes in, the one that follows must put in one more brick.”\n  - Emphasis on long-term vision and political will; replacing prior policies is seen as costlier than building on them.\n- Historical policy priorities:\n  - In 1869 Costa Rica made primary school education free and compulsory.\n  - The country provides free education and a guaranteed state pension.\n- Civic and elite orientation:\n  - Political science perspective: Costa Rica’s elites have maintained well-being through sustained poverty reduction efforts; percentage of people living in extreme poverty had fallen until the COVID-19 crisis hit.\n  - Environmental policy shift in the 1970s (addressing deforestation and hydropower concerns) contributed to Costa Rica’s emergence as a global green pioneer and to job creation linked to a greener environment."
    },
    {
      "heading": "Analysis and interpretations from interviewees",
      "content": "- Luis Alberto Vásquez Castro (former congressman): connects health, work, social time, and happiness to the \"pura vida\" ethos.\n- Professor Mariano Rojas (economist):\n  - Attributes high well-being to strong social relationships and a slower pace of life; links access to primary care with lower spending and longer life: “People who are happy live longer. That’s why you need to spend less.”\n- María del Rocío Sáenz Madrigal (former minister of health):\n  - Emphasizes community delivery of care, improving living conditions as part of investment in health, and the comprehensive vision of health and wellness.\n- Cristina Eguizábal (political science professor):\n  - Highlights enlightened elites and the role of public policies in maintaining well-being and reducing extreme poverty."
    },
    {
      "heading": "Policy implications and lessons",
      "content": "- Prioritize community-oriented primary health care:\n  - Assign local multidisciplinary teams (EBAIS) to households, combine household assessments with electronic health records, and use data to target higher-risk areas.\n- Build durable, incremental reforms:\n  - Maintain a \"social pact\" approach where successive governments add to, rather than dismantle, prior investments—requiring long-term vision and political will.\n- Invest in social determinants of health:\n  - Address living conditions, education, and environmental sustainability as part of health investment to improve outcomes and contain health spending.\n- Leverage environmental policy for economic and health co-benefits:\n  - Protecting and greening the environment can sustain energy and jobs, contributing to overall well-being.\n\nSource: \"Costa Rica Prioritizes Public Health,\" Analisa Bala, March 9, 2022.\n\n---\n\n\n References\n\n- https://www.imf.org/en/News/country-focus\n- Chart of the Week\n- Finance & Development: A Life Well Lived\n- Costa Rica’s President: “No Growth and Poverty Reduction Without Economic Stability”\n- Costa Rica and the IMF\n- Finance & Development.\n- December 2021 health issue\n- https://www.imf.org/en/home\n\nSource: https://www.imf.org/en/news/articles/2022/03/09/cf-costa-rica-prioritizes-public-health"
    }
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    "Authors: Analisa Bala March",
    "Published: March 9, 2022",
    "Article by Analisa Bala, March 9, 2022.",
    "Highlights Costa Rica’s long-term emphasis on public health, social welfare, and well-being as factors underpinning high life satisfaction (\"pura vida\").",
    "Notes Costa Rica’s ranking in the 2021 World Happiness Report: 16th happiest place on earth; aside from the Czech Republic, the only emerging market economy in the top 20.",
    "Universal access:",
    "Historical investments and outcomes:",
    "Primary health care model (EBAIS):",
    "Measured impact:",
    "\"Social pact\":",
    "Historical policy priorities:",
    "Civic and elite orientation:",
    "Luis Alberto Vásquez Castro (former congressman): connects health, work, social time, and happiness to the \"pura vida\" ethos.",
    "Professor Mariano Rojas (economist):",
    "María del Rocío Sáenz Madrigal (former minister of health):",
    "Cristina Eguizábal (political science professor):",
    "Prioritize community-oriented primary health care:",
    "Build durable, incremental reforms:",
    "Invest in social determinants of health:",
    "Leverage environmental policy for economic and health co-benefits:",
    "[https://www.imf.org/en/News/country-focus](https://www.imf.org/en/News/country-focus)",
    "[Chart of the Week](https://www.imf.org/en/Blogs/chart-of-the-week)",
    "[Finance & Development: A Life Well Lived](https://www.imf.org/Publications/fandd/issues/2021/12/Countries-lessons-life-well-lived-Bala-Behsudi-Jaquiery)",
    "[Costa Rica’s President: “No Growth and Poverty Reduction Without Economic Stability”](https://www.imf.org/en/News/Articles/2021/03/01/na030121-costa-ricas-president-no-growth-and-poverty-reduction-without-economic-stability)",
    "[Costa Rica and the IMF](https://www.imf.org/en/Countries/CRI)",
    "[Finance & Development.](https://www.imf.org/en/publications/fandd)",
    "[December 2021 health issue](https://www.imf.org/external/pubs/ft/fandd/2021/12/index.htm)",
    "[https://www.imf.org/en/home](https://www.imf.org/en/home)"
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