This paper will look at the following; Costa Rica’s health status of the population & the healthcare, the general organization of health care system, functions of the Health system, factors affecting health care system, healthcare system in relation to the rural population
Introduction
This is a Central American country that lies between Nicaragua to the north and panama to the south. Costa Rica occupies a space of about 51,100 square kilometers in average It has a population of around 4,191,960 at a growth rate of about 1.35%,birth rate of about 17.8/1000, infant mortality rate of 9,3/1000, life expectancy of about 78, density per square km 82. Its capital city is San Jose which is considered to be the largest city occupying a space of about 1,527,300. The official language used is Spanish and English. It has a wide compositional ethnicity groupings that are found within its boundaries these are, the white race which accounts for nearly 93%, the black race which accounts for nearly a percentage of 3%, the Amerindian, Chinese and other races account each for 1%. (Benjamin, 2008).
They are religious people by taking a sample of people who practice some form of religion to be almost 96% while the rest 4% don’t practice any kind of religion. The level of literacy of inhabitants is high, this accounts to nearly 95% of the population are literate. Costa Rica’s climate can be classified as tropical, it has no winter or summer but it experiences a dry spell from the month of December to April while the rainy season takes from the months of May to November. The temperature goes up to an average of 71 Celsius degrees. (Benjamin, 2008).
Health Care System
A health care system of a region is measured using the following; healthy life expectancy, health performance, health expenditures, and the percentage of gross domestic product of a country. These are the standard measures used by the World Health Organization. According to their survey they rated Costa Rica as being number 36 world wide. Costa Rica is also ranked as the third country in the world in life expectancy which currently stands at 78 years of age. Factors contributing to a good healthcare program in Costa Rica can be affiliated to its laid back lifestyle by its citizens, the healthy fresh foods that the country offers, by the fact that its an agricultural country that majors in agricultural activities mainly coffee growing, banana planting and sugar plantations, a well fed nation is definitely a healthy nation. Considering that most illnesses are brought by an insufficient nutrition back ground. (Benjamin, 2008).
The tropical climatic condition experienced in Costa Rica again boosts a healthy lifestyle among its citizens. Another factor influencing the growth of the health care system in Costa Rica is the full government commitment which essentializes the need of an affordable healthy care system to its citizen by providing accessibility to it. By the fact that Costa Rica has been able to operate without a standing army and has committed to the social and educational welfare of its citizens has majorly contributed to a good foundation that has led to a more elaborate medical system. The government has sponsored a network of nearly 30 hospitals and more than 250 clinics countrywide; this has been affected by the incorporation of Costarican social security fund whose main delegation is that of providing an affordable health care system. Apparently even foreigners visiting Costa Rica have been offered an avenue in which they can seek for medical care services. This is facilitated through joining Costarican social security fund and paying a small contribution fee which is on a monthly basis this is subsidized from their income. Medical practitioners are trained within Costa Rica after which they expand their knowledge from traveling all over the world to expand and exercise their new found knowledge.
It’s a fact by the day that most people visiting Costa Rica go there with the main reason being that of consulting about their medical problems. Hence Costa Rica can be said to be offering a universal kind of health care system. Healthy care system in Costa Rica has evolved from the basic form of medical service to constructive surgery like plastic surgery to reconstructive surgery and dental implants. For a country to enjoy such an exclusive health system it has to have a well planned organization that is fully supported by the state.
General organization of Health Care System (Costa Rica)
The public sector of the health services system is made up of the Costarican social security fund (CCSS). Its main role is that of providing a healthy insurance cover, which includes a comprehensive health care, providing financial and social benefits to its citizens. This is further facilitated by the National Insurance Institute whose main role is to cover occupational and automobile accidents. The Costa Rican government has put in place a water Supply Institute known as the Costa Rican Institute of Water Supply and Sewerage Systems this helps in distributing clean water and disposal of waste water. The main player in the health systems in Costa Rica is the ministry of health whose main role is delegating, and monitoring the performance of the earlier mentioned health functions. (Michael, 2006).
For a health system to be effected fully there has to be a system implementer and regulator and this is well coordinated by the Ministry of health. The ministry of health is a branch of the executive that is the government while the insurances, social security fund and the water and sewerage supply systems are separate entities, which operate on their own set statues and resources. These entities are run by a board of directors and an executive president. Incorporated in the Costa Rican national health system is the University of Costa Rica and all the government municipal council, this was implemented through the law of general health. The government supports the national health system by providing comprehensive budget through the ministry of finance that supplement areas of research on nutrition and health which is facilitated by the institute of research on nutrition and health, the national centre of prevention of drug abuse and the institute on alcoholism and drug dependency, the government has identified the above mentioned entities as major contributors of the national health system, in Costa Rica thus the need to fund them in order to help them with implementation of health care issues.
Through laid down laws on general health and public administration the ministry of health takes the role of coordination making all the systems involved to run in unison and smoothly. To facilitate it even further the government has set up a national health sector council that deals with health problems affecting the public, they are mandated to make major decisions on how to deal with this public health problems for instance the campaigns against tuberculosis and infant mortality, research on human subjects and evaluation of hospitals. By diversification of each of the above-mentioned sections that deals with health matters it makes the work of the ministry of health easier hence the ministry of health performs sect oral steering functions. Also the ministry of health continues to offer nutrition and education programmes to children under the age of 7 years from poor backgrounds setting. In order for real implementation the ministry of health has taken a major step of cutting back on its personnel: by this it has a minister and his assistant this is the top most office in the ministry, then follows the general bureau, six central offices, nine health regions in the country and 80 health areas which are distributed all over the country. Through a constitution mandate the Costarican social security fund is mandated to the obligation of offering public services that are intended to cover health insurance, and maternity care for the whole population. Hence they have six offices that are termed as central offices, they have divided the country into seven regions that they offer their services to ,and ninety four health areas thus facilitates their set agendas and enables them to reach and cover the people at the ground level effectively. The Costarican social security fund has an organized structure that consist of health centers, clinics and health posts this centers help in offering services to the public to increase their efficiency, in offering these services they have divided their service care into five comprehensive categories that tend to cover the whole population. These categories include care systems for children, adolescents, women, adults, and the elderly. The Costarican social security fund operates its services from the lowest level of the society this is through the basic comprehensive health care teams; each of these teams is allocated nearly 3,600 people in which they deal with. For the five care systems to pull through its goals the Costarican social security fund has started to sign annual management commitment with the central level whose main aim is to set outcome based goals, this step increases efficiency on the said care programmes because of the evaluation side of it. The Costarican social security fund has included private entities called health cooperatives in delivering and implementing their services to the people at the lowest or basic levels in the society. The results of the above mentioned course has led to a positive feedback by recording high numbers of people covered, the numbers have reached a high of almost 400,000. The area of care programmes is identified as their first level in implementing and offering services to the population targeting the lowest levels in the society. (William, 2008).
The second level of their service delivery comprises of areas of providing consultation services, hospitalization process, medical and surgical procedures for the four assigned basic areas. In order for them to cover the entire population they have established ten health care centers, thirteen peripheral and seven regional hospitals. (Michael, 2006).
The third level of its operations contains the most complex health care provision to the five care groups fore mentioned above. These complexities consist of surgical treatment, and medical. This is administered through three general and specialized national hospitals which are proscribed as follows; for women, children, geriatric, psychiatric, and rehabilitation. The biggest problems faced by the Costarican social security fund is the level of its hospitals being fully facilitated, in such cases such as radiation therapy, ophthalmology and pathological anatomy the system tends to sub-contract other private hospitals. This poses the problem of patients having to undergo long waiting lists as they await treatment. This lists run to high numbers of up to around 15,000, the government has always questioned the high costs incurred during such sub-contracting services to private hospitals. The level of quality of service offered is also questionable in relation to the costs incurred. Through the constitution the law of general health insists that the population is entitled to a full medical coverage in insurance which is not the case, only about 81% of the population is covered. This insurance policies are either contracted voluntarily or through compulsory measurers or as pensioners, or their dependants. For the remaining 19% they are either covered through states subsidies, this is especially so with the population which is under the poverty line, the rest get public health services which they pay for directly after receiving treatment. (William, 2008).
In Costa Rica through present times there is an uprising of upsurge when it comes to emergence of private health care facilities. Nearly 30- 35% of the entire population tend to visit this centers once yearly. A factor leading to the emergence and growth of these facilities mainly is by the fact that the demand of their services is so high when it comes to Costarican social security fund contracting them in provision of health services. This insufficiency has led many people to get medical services from the private entities through a prepaid method of payment (Michael, 2006).
The private hospitals have grown in present times just by taking the number of staff they contract. It has fervently grown from about 10% through the nineties to a high of nearly 25% in the twenty first century. These private entities get their funding from public entities such as the Costarican social security fund and the National Insurance Institute through subcontracting methods that they source from the private facilities for patients who need occupational and general illnesses services. This private facilities include the most affluent facilities such as the Clinica Biblica and Clinica Catolica apparently most of the doctors employed by the Costarican social security fund work in this outlets in the evenings and afternoons as part timers (Norman, 2000).
Functions of the Health System
Steering role: reforms have ensued to develop certain steering roles that the ministry of health should carry out they are as follows: – they are obligated to offer management and leadership skills, they monitor health issues, they regulate services offered, and also offer research and development issues. Health monitoring is coordinated from the central office after which they are disbursed to other regions. The ministry of health hasn’t yet implemented its role in research and development, also it has no influence when it comes to public sector financing which is done by the central government through the finance ministry. The ministry of health can only work on a budget that is given by the finance ministry to follow its expenditure (Pablo, 2008).
The ministry of health has recognized Costarican social security fund as the sole public insurer when it comes to maternity and general diseases. The government has not supported the initiatives of private players in campaigns such as child mortality and HIV Aids, anti smoking and vaccinations hence the ministry of health takes this initiatives alone. The ministry of health regulates and evaluates the health service production and facilities.
Financing and expenditure: financing of public health comes from premiums of social security fund subscribers, which represents almost a total of 80% from the public sectors income and 55 % from income from the health sector it self. Although the treasury too contributes, of late there has been growing tendency for it to decline; hence it’s not counted as a facilitator. Private expenditure takes up the areas of consultations, drugs and dental services this is because they charge highly making most households to take up public health services. They might be costly but in times to come they might add more people in their lists as they implement their pre paid insurance covers (Pablo, 2008).
Health insurance: all inhabitants in Costa Rica are covered legally speaking. The responsibility of offering insurance is assigned to the Costarican social security fund. Insurance has been made compulsory for all salaried workers, and pensioners, the poor are covered by the states while the rest of the population can obtain insurance cover on a voluntary system (Michael, 2006).
Factors Affecting Health Care System
The steering role of the ministry of health lacks support from the main players for instance the carrying out of campaigns such as anti smoking campaign, the government has to include the private sector this will help to relay the information to greater masses and may be even more effectively. The government also lacks a good information system net work this should be enhanced to enable free flow of information concerning some health risk factors especially during pregnancy and other major diseases such as cancer and H.I.V. A good established coordination Programme between all units involved in delivering of public health service should be established, for instance the coordination of ministry of health and the Costarican social security fund should chip in times of evaluation and implementation of health initiatives posed by the ministry of health, a good example is like when the ministry of health came up with the idea of improving quality of care programmes this has never been implemented hence the rise of complaints by the masses (Margret, 1999).
The ministry of health has no legal influence on accreditation of institutions that offer high learning when it comes to the health human work force this is because another different entity covers that section(national council of higher education) this will eventually lead to corrosion of the set standard of service delivery by the practitioners. Proliferation of private educational institution is yet another problem poised ironically Costarican social security fund students overflow such facilities to gain knowledge from them. Another problem affecting health system is the act of having a regulatory system that checks on quality of drugs but this mechanism are lacking when it comes to checking on the quality of medical devices, and equipment. The above problem can be said to be reviewed but the implementation is yet to take place this is by the government and the Costarican social security fund proposing the planning of a health care system that will intervene in basing scientific evidence and the rational use of technology (Norman. 2000).
Another problem affecting health care system is that of Financing and expenditure, although this information is in public domain and it is timely the way to interpret it brings a problem; there is no fundamental method of consolidation that has been coined to do this. This leads to interpretation of different variables to be seen as of the same value, which is misleading to the public eye. Information on financial issues is well safe guarded when it comes to private entities (Norman, 2000).
Healthcare System in Relation to the Rural Population
Despite the elaborate health care system in place in Costa Rica the rural population has its own set of problems. This is because equity in distribution of health facilities has become a stumbling block this has been caused by the way health services are being distributed in consideration of population segments, attributable to deficiencies in resource allocation and management. The resources are not equably distributed to provinces by factor s of population for instance beds and personnel according to research carried out the number of physician and nurses were about 15 per a population of nearly10,000 people. The lowest of averages were recoded from the rural settings where infant mortality is high and maternal deaths are significantly high too. This implies that human resources in perspective of health care services are centralized. The imbalances compared from the urban canters and rural areas are clear, for instance the average number of beds at the national level is at 20 per 10,000 populations while that at rural areas is at 9 beds per 10,000 population in an act of implementation taken in the same year. Hence the need of increasing equitable distribution of human and material resources in order to have a comprehensive medical plan for the whole country other than offering a system that segregates (Norman, 2000).
As an inhabitant what would I do to maximize health issues? For one I would make sure that I enroll as a member of the Costarican social security fund, by this I would be able to benefit from being insured medically, I would invest a lot of my time in knowing what kind of campaigns the health care was offering me as a citizen and take the opportunity to my stride. Although the government will have taken the initiative of offering me a public health care it also tends to be on the offside when it comes to offer me complex services like for instances, that of surgical operations, for this reason I would opt to have a private cover that guarantees me the service up front other than waiting for the long lists at the operating room. By analysis it seems that people living at the rural sides are disadvantaged I would obviously choose to live in the urban setting where modern health care systems are in place and resources whether human or material are in plenty.
As a person living in Costa Rica I would take a personal initiative to educate the rural poor on the kind of policy that the government has in place for them so that they don’t languish in poverty, ignorance and sickness. For my sunset years it would be wise for me to get covered so that I don’t die due to lack of funds for medication. In the mean time I would instigate the public on what is affecting the rural population when it comes to resources, infant and maternal mortality, this could make the government to revisit its mandate by giving equal services to the rural poor who are prone to medical problems (Norman 2000).
As a consultant I would advice the government to implement the following: it should forbid its public servants from working in private institutions as part timers. Because this act corrodes the ethics of being a good worker, they cannot be allowed to serve two masters. Private outlets tend to pay more, meaning that the public practitioners would evade duty to be paid more in private outlets. This would bring an outcry of corruption in the public sector, for instance doctors can send patients to known private outlets so that they attend to them later and gain more money. The government should also take the initiative of establishing their own medical schools that should be registered under the ministry of health. This will prevent quacks from entering the work force exposing its citizens to more problems than what they already have. The government should also find ways of coordinating with the private sectors when it comes to campaigns such as tuberculosis, anti smoking, HIV, in order to open communication lines and streamline the information to the areas covered by the private sector.
The government should device a method of putting up initiatives and implementing them other than shelving them in government libraries to gather dust. This they will do when they bring into play the private sector and the public sector together. Hence the economic factor of growth can be realized and these funds can be directed to a more effective well equipped public hospitals with new technologies set into place. The government should train more social workers and community workers whose main work is to enlighten the rural population on health related issues such vaccination and other communicable diseases. The ministry of health should be accorded its own budgetary system to increase efficiency so that implementations of building more hospitals, buying new equipments for the hospitals can be realized with eases other than waiting for approval from the ministry of finance. The government should take the initiative of decentralizing its service from the urban centers to the rural areas this will also reduce the influx of rural -urban migration, which may lead to problems of pollution, and lack of enough social and physical amenities to support the huge population.
Observations and Conclusion
A health system can only be rated as good if it sufficiently caters for its population in a wholesome way. The public can only gain from a good health care system if all section of the society is included that is the public sector, the private sector, the government and the populace in general. Equitability in terms of human resource and material resources is fundamental when it comes to enjoying the full benefits of a good health care system. In order to have a good and efficient health care plan the government commitment and support is needed.
The public should also use the services as required by contributing effectively to the national insurance fund put in place. If this is done effectively, it will boost the government’s capacity to help the poor in the society, meaning a more comprehensive health system.
Benjamin L. (2008) Performance – based contracting health services in developing
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