Patients of the Hospital Calderon Guardia in San Jose RODRIGO ARANGUA/AFP/GettyImages

What Happens When Primary Health Care Is Universal?

Since the 1990s, one of Latin America’s smallest countries has built a system of primary health care that reaches nearly every citizen. Four key reforms underpinned this progress, and offer a model that other countries pursuing universal health coverage should consider.

BOSTON – Two years after the death of her husband, Valeria, a 67-year-old grandmother in San José, Costa Rica, lives alone. Last year, she was diagnosed with high blood pressure and diabetes, conditions that, while not immediately life threatening, require health care to manage. But, thanks to the quality of Costa Rica’s primary health-care system, Valeria has been able to maintain her independence and her health, even in the absence of family.

Costa Rica, a middle-income country that is committed to universal health care for its people, produces better health outcomes, while spending less than most other countries in the world. In fact, Costa Rica has achieved the third-highest life expectancy in the Americas – behind only Canada and Bermuda, and well ahead of the United States. The secret of its success is revealed in our new report, “Building a Thriving Primary Health-Care System: The Story of Costa Rica.

After her diabetes diagnosis, Valeria was automatically entered into the diabetes chronic-care program at her assigned clinic, a ten-minute walk from her house. She visits with her primary-care team every three months to have her blood pressure checked, and to make sure her diabetes is under control. And, once a year, a community health worker visits her home to ensure that it is safe, to administer vaccinations, and to share information about maintaining a healthy lifestyle.

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