Costa Rica's Public Health System
I am a big fan of Costa Rica’s public health system, known locally as the Caja. Back home in the States, I paid hundreds of dollars each month, plus my deductible and co-pays to stay insured. Here, my monthly contribution is less than $50, and I have access to a variety of medical services such as yearly checkups, dentist appointments, and prenatal care – all with highly trained physicians.
More expats are starting to take advantage of the public health system, as legal residents of Costa Rica are now required to pay into the Caja. At the very least, you can get your yearly well visits, vaccine boosters, and some prescription medications for the cost of your monthly contribution. You’ll also be entitled to preventive care like dental exams, colonoscopies, and mammograms. For non-emergencies, small clinics known as Ebais are located in almost every community. Like many socialized health programs, the Caja has its drawbacks; here are some tips to facilitate your next visit.
Depending on the size of your town, your local clinic may have separate service windows for residents of different neighborhoods. Your carnet ID card may indicate your section, but make sure to ask. You can only make a doctor’s appointment at your assigned service window, and if you queue at the incorrect one, you’ll lose your place in line.
Get in Line Early
Caja doctor’s appointments are first-come first-serve, so it’s important to arrive well in advance of the opening hour. Most clinics open at 7 a.m., and in a small town, arriving at 6:30 is usually sufficient to secure a spot. In more populated areas, you’ll want to get there at least an hour early.
Caja receptionists give almost everyone the same appointment time – usually the opening hour. Doctors often arrive half an hour later, meaning the first appointment is already 30 minutes behind schedule. Depending on your place in line, you may have to wait a few hours for your appointment, even if your ticket states 7:00 a.m.
The Caja always requires patience; you’ll wait for the day’s appointment, for prescription medicines, for test results, and for referrals. Try not to get frustrated. Costa Rica is built on process, and the Caja is no different. You’ll get results; you just have to wait longer for them than you would back home.
Bring a Snack & Book
On any visit to the Caja, always go armed with a snack, a drink, and some form of entertainment. I think of it as extra time to myself, and look forward to reading or listening to music while I wait.
The Caja is compartmentalized, so the doctor will only do basic tests – throat swab, listening to your lungs, etc. – on the spot. She’ll probably refer you elsewhere for additional tests, like blood samples and urinalysis, which are taken at the Ebais. For other specialized exams, you may be directed to the local hospital or larger clinics, and major appointments will be referred to the nearest public hospital.
Wait Times for Referrals
To schedule referral appointments, take your referral slip to the designated location, where you’ll wait in line to make an appointment. Except in urgent cases, your appointment will not be for that same day. Wait times can easily exceed six months, so when I get frustrated by the constant back-and-forth, I just remind myself that the Caja provides excellent healthcare for a small price. As long as I stay on top of my appointments, I can afford to wait a few months for my next preventative checkup.
Note that pregnant women and citizens 65 and older have preferential status with the Caja. You’ll have access to pre-scheduled appointments – set for a certain hour on a certain day, with little wait time – and pregnant women are allowed move to the head of the line. Instead of waiting months for a dental exam, you’ll have a basic exam within days of the doctor’s referral, and cleanings will be scheduled in advance every few months.