Comprehensive Primary Health Care Reform in Costa Rica

In the past, Costa Rica was characterized by a duplicative and fragmented public primary healthcare system. In 1994, the country initiated a sweeping reform of the health system, including primary health care. Bureaucratic reorganization of the Ministry of Health (MOH) and the Social Security Agency (CCSS) led to the integration of all healthcare delivery under the CCSS, from public health activities to tertiary care. Comprehensive multidisciplinary primary healthcare teams (EBAIS)—comprised of a doctor, nurse assistant, community health worker, and data specialist—were created to care for approximately 5,000 patients each. A system of geographic empanelment was implemented to assign every Costa Rican to one of the newly-formed EBAIS teams. Finally, quality assurance mechanisms were initiated and promoted data collection and feedback central as a central function of the EBAIS teams. The first EBAIS team was established in 1995 and by 2002, there were 818 active teams throughout the ...

High Quality Primary Health Care in Action: The Story of Costa Rica

Costa Rica’s primary health care system is supported by robust integrated care teams that provide comprehensive, coordinated, continuous, and person-centered care to empaneled populations. As a result, health outcomes in Costa Rica are consistently strong and improving.

Building a Thriving Primary Health Care System: The story of Costa Rica

Situated in Central America, Costa Rica’s 4.9 million citizens have access to one of the most effective primary health care systems in the world. The country’s unique, team-based model of primary care service delivery successfully combines preventive and curative care to provide comprehensive primary health care to nearly all Costa Rican citizens. This case study examines the process by which Costa Rica developed its laudable primary health care system, fully describes the functioning of the system through both clinical and patient perspectives, and elucidates key lessons about primary health care delivery that can be learned from the Costa Rican experience.

Primary Health Care That Works: The Costa Rican Experience

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica’s innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica’s experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Implementing High-Quality Primary Care Through a Health Equity Lens

The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic.

The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report’s framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion ...