Not Just Numbers

Students on the 2017 program in front of the Calderon Guardia Hospital in San Jose, Costa Rica with Dr. Chaves.

Reflection 1 – Serena Carlson

We can begin to compare the U.S. and Costa Rica by looking at a few indicators; GDP and HDI within healthcare metrics. The U.S. spends roughly 17% of it’s GDP on healthcare, while Costa Rica only spends 9%. Per capita spending for the U.S falls around $9,400 per person and $1400 for Costa Rica. These are vast differences that mean real dollars and funds diverted.

Another metric to measure between countries is the HDI (Human Development Index). This metric evaluates and measures the quantity of life, overall well-being, and one’s standard of living. Basically, one’s quality of life. There are 188 countries that use this index and the U.S. measures at 8 and Costa Rica measures at 69. Other factors that influence this measurement are: life expectancy at birth, and years of education. Norway comes in at number 1 in this index.

Clearly it appears we have a higher HDI, or a higher standard of life, but do we have a better quality of life or standard of care? There are other factors to consider and measure. Infant mortality rates in the U.S. is 6.1 live births for every 1,000. Costa Rica measures at 8.7 for 1,00 births. Life expectancy for the U.S comes in at 78.8 years and in Costa Rica it comes in at 79.3. Costa Rica has overall longer life expectancy rates than the U.S. Additionally, the U.S. spends the most per patient worldwide and comes in at number 48 overall in outcomes worldwide. This indicates throwing money at a problem doesn’t solve it or provide better outcomes.

These are just numbers and are easy to get lost in translation. Each one of these number listed above equates to a human life. Today I visited The Calderon Guardia Hospital in San Jose, Costa Rica. It was an eye-opening experience. We met with Dr. Eli Chaves who specialized in Geriatrics. He spent 2.5 hours with me and other students. He gave us a detailed explanation of Costa Rica’s universal healthcare system. He also provided us with a tour and detailed explanations on quality and standard of care at his hospital.

On our visit, several things stood out to me of what we can takeaway from Costa Rica: preventive care visits, maternity and post-natal care. In Costa Rica it is common place for elderly patients to have 4 physical checkups: to check in with the patient, monitor their chronic conditions such as dementia, coronary issues and mobility. In the U.S. elderly patients receive one annual visit. Medicare only pays for one each year. Prior to the ACA preventive visits were not covered. Costa Rica sees a patient every 3 months for follow up and to coordinate care. In the U.S. it’s once a year unless an issue arises. Clearly, Costa Rica is aiming for true preventive care. Their model is proactive versus the U.S’s model which seems to be reactive. Dr. Chaves also explained how visits are made to the elderly patient’s homes for follow up if they are not able to make it in to the hospital. We do not have currently have such supports in place.

The maternity and post-natal services in Costa Rica are very different than what we have in the U.S. We spoke with Dr. Barrientos, who specialized in Pediatrics and then went on to gain another specialty in Neonatal medicine delivers healthcare to mothers and babies. Dr. Barrientos cares for the most weak and youngest infants in San Jose. She gave us a comprehensive overview of how her nation delivers healthcare to its women and infants. First off, Costa Rica only has 10% of its births via caesarian. The U.S has about 38%. That means 1 in 10 babies in Costa Rica is delivered via caesarian and in the U.S., almost 4 out of 10. That’s a 30% higher frequency in the U.S., not something to ignore.

While in the hospital I observed how Costa Rica practices maternal and fetal medicine. Two takeaways were infant care and breast milk support. In Costs Rica, the baby stays with mother at all times and shares the same bed to create bonding for both mother and baby. We never see this in the U.S. I never witnessed a brand new baby sharing the same bed with their mother while being moved throughout the hospital. The baby and mother do not have separate beds, they share one. The mother and child are immediately supported in the hospital. Prior to discharge, each mother is sent home with a packet filled with support and services needed foe the infant’s first year of life.

The other large takeaway was breastfeeding. Breastfeeding is highly promoted and only in exceptions formula was provided. A huge progression in what Costa Rica practices is their breast milk bank. This bank keeps breast milk on hand for premature babies, for babies needing extra care or for mothers who have trouble lactating. The hospital asks all mothers to pump extra breast milk and it is sent to the milk bank at a neighboring hospital in San Ramon, Costa Rica.

After the first day it is amazing to see how a poorer nation is striving to provide excellent healthcare to its citizens. The downfall of the U.S. is its outlook on how it views healthcare as an interchangeable commodity and privilege. Costa Rica views healthcare as a right and its mission is to provide equal access to all citizens. The U.S. can learn from Costa Rica and how It delivers healthcare to its citizens.

The author of today’s blog, Serena Carlson. Serena is a junior and a HPA major.

They symbol of the health care system in Costa Rica is a mother and child.