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Jean-Pierre Unger, MD, PhD, MPH, Pierre De Paepe, MD, MPH, René Buitrón, MD and Werner Soors, MD, MPH

Jean-Pierre Unger, Pierre De Paepe, and Werner Soors are with the Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. At the time of the study, René Buitrón was with the Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito.

Correspondence: Requests for reprints should be sent to Jean-Pierre Unger, MD, PhD, MPH, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium (e-mail: jpunger{at}itg.be).

ABSTRACT

Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance.

Costa Rica’s population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system.

However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system.