According to a recent Harvard Chan School of Public Health recent seminar entitled Inside Costa Rica’s healthcare success story the “average life expectancy in Costa Rica has steadily increased from 55 years in 1950 to 81 years today—far outpacing the U.S. Even more notable: the country has achieved this success while spending far less than the U.S. as a share of income. What’s behind Costa Rica’s remarkable success? How has its progress in health care improved its resilience? And what lessons can we learn for other nations?”
The facts are astounding. Costa Rica’s life expectancy was 13 years shorter than the U.S. in the 1950s and now is two years longer. Costa Rica spends 8% of its GDP on healthcare versus the U.S. which spends 18% and rising. Worldwide health care spending averages about 10% of a country’s GDP.
We have a sickness system whereas Costa Rica has a health system. We are great if you are acutely ill, need high tech, have insurance, and the agency to navigate the system. Living longer in America is challenging but possible by embracing prevention and healthy lifestyles.
Examples abound for both sickness and healthy regions. Tampa Florida, a beautiful growing metropolitan region, proudly announced two new proton beam radiation therapy centers coming on-line within the next few years. The centers will be about a twenty-minute drive from each other. Although controversy about efficacy versus cost has settled down for the relatively new radiation therapy treatment for certain types of cancer the cost per center ranges from $20 to $150 million. Many cancer patients will benefit for sure, but what if many of these victims avoided the disease in the first place? Or if some small part of the funds were directed to well-being and health?
In distinct contraposition, a successful prevention approach was embraced in Southwest Florida with the Blue Zones Project. The University of Wisconsin Population Health Institute validated an increase in life expectancy of 0.6 years for 400,000 people across the socio-economic spectrum from 2015 to 2020. Most of the rest of the nation’s life expectancy dropped during the same time, but not Collier County. Diet and lifestyle influence one’s chances of developing a dread disease. Would all cancers have been avoided, certainly not. But many people lived longer and the cost of nudging folks to healthier lifestyles was negligible compared to cancer treatments.
How did Costa Rica become a model for not only us but also the world? The answer: incremental improvements and a systemic organization focused on health, not only disease. Note the small changes occurred yearly over eighty years starting in a country that is about the size of West Virginia and has 5.2 million people with environments ranging from dense inner city to remote rural. Seven regions, each with teams composed of a family physician, nurse, community health worker, and medical records clerk visit each home one to three times per year depending on the needs of the citizens. Years ago, starting with vaccinations, then mother/baby care, and subsequently extending throughout lifespans resulted in success.
Additionally, in the 1990s a universal health care record was created. Not only does most of the country have good internet capability but also about 65% of the homes are geospatially identified. Some families are so remote a helicopter is required to visit. The health record system also links nearby homes in need so the teams can be efficient with travel times, ultimately saving funds.
Surprisingly, lower income groups have a slightly longer life expectancy than others. Investments early in the program avoided the care and life expectancy disparities experienced in other nations, including ours, among minorities and resource stress populations. Everyone benefits from the systemic educational preventive approach, not just those with insurance and the ability to navigate the system.
The U.S. spends about 5% of the healthcare dollar on primary care. Doubling the resources for education, lifestyle modification, and prevention would decrease the 80% of self-induced illness. Money saved would more than pay for the upfront investment and the overall spend would decrease. Avoiding chronic diseases such as diabetes and cardiovascular problems also prevents misery and disability.
Interestingly, the U.S. government is the major payor for healthcare by managing Medicare, Medicare Advantage, Medicaid, CHIP (Children’s Health Insurance Plans), Native American Health, Federally Qualified Health Clinics, Veterans Administration, and other entities by paying for quality and efficiency. Resistance to change by incumbents is always a challenge but really, who wants to spend a night in a hospital or go through prolonged treatment?
Missing the Boat by not embracing an organized prevention program has been explained. Profit margin squeeze, the tyranny of the present, learned helplessness, and not-invented-here helps explain the failure of the U.S. healthcare “system” to extend healthy life expectancy. COVID highlighted our flaws. Perhaps now we may be more motivational to support systemic change.
Costa Rica’s integrated medical record was a major advantage during the early onslaught of COVID. Costa Rica has only 1.1 beds per 1,000 people. Other nations have twelve times the ratio. The U.S. has 2.8 beds per 1,000 but during COVID, initially we were not coordinated with our medical records nor surge plans. Costa Rica had the ability to vaccinate efficiently and was the fortunate recipient of vaccine that was about to expire and would have been wasted by other nations without the capability to vaccinate efficiently. COVID doesn’t respect geographic borders so having a government responding to science along with a mature system that touched everyone helped decrease mortality even though the number of hospital beds was miniscule compared to other “rich” but disorganized nations.
If our goal is to help everyone live a longer, happier, and healthier life, we need look no further than Costa Rica. Objectively, incremental systemic improvement over eighty years does increase live expectancy while decreasing costs.