Breaking Pura Vida - Medical Care in Costa Rica

How to navigate a better, more healthy, less costly healthcare system than that in the United States.

View from a hospital room in San Jose, Costa Rica.

Again this is my series on living in Costa Rica, trying to help you avoid the glaring potholes of uprooting your life to move here. It is named “Breaking Pura Vida” because just like what you don’t know can trip you up in “Breaking Bad” so can moving here without accurate information. “Pura Vida” means pure life and happens to be the national slogan and attitude. Previous entries about if you should move here and the banking system can be found here.

Today I am going to talk about the best reason to move to Costa Rica. Health and healthcare. Health should be pretty obvious by now. It’s a place with low stress, warm weather that allows you to exercise daily, access to fresh fruits, vegetables and meats inexpensively, and the famous “Blue Zone.” Cleaner drinking water than Stateside and no industrial pollution round out the health picture. It’s glaringly simple.

I also have good news about healthcare here - it is world’s better and much cheaper than in the United States. Healthcare here is divided into two distinct spheres, private healthcare and public healthcare.

To access the public healthcare here you have to either be a citizen or a legal resident. It’s that dreaded healthcare that U.S. based insurance companies decry: socialized medicine. It’s good basic care, but it’s bare bones. If hospitalized it will usually be in a very basic hospital ward with other patients. There may be long waits for surgery, but on the plus side you can fill your prescriptions at no cost. The costs for this care are monthly stipends that you pay and a small nominal fee you pay to access healthcare.

The private sector is no different in the types of care and level of Western luxury you might encounter in the United States for a huge fraction of the costs. In just the last year my husband had invasive surgery for prostate cancer that didn’t go well. It was nothing that the hospital or doctor did, it involved a hospital acquired infection picked up in the United States during an emergency three days in the hospital over Christmas. Involved him being admitted for long stretches to clean his incision and get IV antibiotics. Guess how much out of pocket we are after a year dealing with this? Under a hundred dollars. Our insurance company was happy to reimburse us for the care that ran a small fraction of US prices.

Most of the time we end up paying anything not a hospitalization, but much of the time the total bill to be seen works out to be about the same as our insurance has as a copay in the States. We file with insurance and are reimbursed. It’s dramatically cut our healthcare expenses even as we’re had a few interesting misadventures through the last eight years.

So that’s the other thing. Some U.S. based private insurances do work here. Not all of them, but there are a few. Some work just like the States and if you are hospitalized if you make sure to use a preferred provider and facility it may well be free.

You can buy health insurance here too. That can help manage your out of pocket costs. But let’s face it, there are huge groups of folks here on a tourist visa that don’t bother with insurance, paying just out of pocket.

There’s no shortage of healthcare workers here, and you’re given a level of care I’ve not experienced before moving here. The healthcare system is open to using more natural options than in the States. One of the best things is that many clinics here are open 24 hours a day, 7 days a week. I have rarely ever had to wait to be seen even as long as sometimes in the States.

Back over Christmas 2023 we got to contrast first hand the care given in each nation. Several days before a planned visit by to the U.S. my husband was scratched by one of the stray cats he’d been feeding. Went to the doctor here. She washed, ointmented and bandaged the wound, telling my husband to watch because it looked like it was getting infected, so she was prescribing a broad spectrum antibiotic. Didn’t require stitches. She warned us that if it got worse to get to the ER right away, but be warned: In the USA all cat scratches or bites that break the skin and show up with a fever ended up with the dreaded rabies shots. She didn’t deem them necessary because the cat and dog population here does not have active rabies among them. It’s just not a program here. Now a raccoon bite on the other hand might earn the shots. Total bill $60 and after insurance it would be a munificent $9 bucks.

We flew home the next day and by the morning of the day after his arm was swollen and red. Started calling around trying to get him seen. After a five hour wait he was finally seen at a doc in the box place who turned around and ordered him to go to the ER. Bill at the Doc in the Box was well over a $100 bucks.

Onward to the ER. We arrived at noon at a university hospital they called, and after screening we waited in the jam packed waiting for six hours before he was taken back for treatment. Four more hours pass before they start looking at and treating the wound. Immediately started on IV antibiotics, orthopedics, and a hand surgeon was brought in. They insisted on giving him those rabies injections, no matter how many times we told them that Costa Rica doctor said it was unnecessary. They scoffed.

It took until a total of 12 hours back in the ER for the decision to be made to admit him. There was just one problem, zero beds open in the hospital. For the next 24 hours he’s camped out in the ER, and we watch as the hospital starts turning away ER patients because they are beyond capacity. They move him to a room about 24 hours left in his three day stay for monitoring and IV antibiotics. Before it’s over with the hospital tries to hit us with a bill for 6K being our responsibility. If that was 15% just imagine how expensive that is.

The scary thing about the experience is that the hospital was incredibly understaffed. Understaffed and overstuffed. When we got back to Costa Rica he finished up the rabies injection. An injection that the hospital billed our insurance at over $1,600 that cost us $25 dollars here.

Many prescription drugs here are over the counter, and all of them a mere fraction of costs in the States. My monthly Lyrica bill before insurance runs about $80. In the States Lyrica without insurance would run around $1,600. Who can afford that?

I may be updating this with an addendum after I recently discovered a sleep lab, sleep doctor and retail medical supplies outlet to get a new Cpap machine. Instead of jumping through the hoops of multiple specialists appointments in the US taking at least several months to navigate through to get scheduled for a sleep lab and new Cpap machine here I just picked up the phone and scheduled it. Will be explaining how that goes when it happens.

This is just meant as a broad overview. I’m going to break it down here even further since this is one of the most frequent questions I get about live here.