The Costa Rica

-The New Yorker Magazine-


Costa Rica’s per-capita income is a sixth that of the U.S., and they spend a fraction of what we do on health care, but life expectancy there is longer. That happened when they made public health central to the delivery of medical care. Every Costa Rican is assigned a local primary-health-care team, which includes a physician, a nurse, and a trained health worker known as an ATAP, who visits every household in the community at least once a year. Earlier this year, Atul Gawande accompanied Leonardo Herrera, an ATAP in a small mountain town, on his home visits. “There was nothing magical about the care I saw that day,” Gawande writes. “Herrera wasn’t a saint. But he may have been something better than that: he was the point of contact between a national system and a great many individual lives.” This is a story about what Costa Rica can teach the rest of the world about public health.

We’ve starved our public-health sector. The Costa Rica model demonstrates what happens when you put it first.

In the United States and elsewhere, public health and medical care are largely separate enterprises. Costa Rica shows the benefits of integrating the two—it spends less than we do on health care and gets better results.

Álvaro Salas brought his work at community clinics to bear on national policy.

Leonardo Herrera, an ATAP in Atenas, is responsible for making home visits to an estimated fourteen hundred households in the area.

Herrera checked on a patient with cerebral palsy. Individuals who have certain severe disabilities or conditions average three preventive visits from an ATAP every year.

For each household, Herrera keeps an updated ficha familiar, a family file that provides the primary-care team with medical updates as well as detailed notes on living conditions.

When Salas was growing up in Atenas, the nearest hospital was sixteen miles away, and understaffed. Now the area’s roughly thirty thousand residents are served by seven fully equipped EBAIS teams.

Herrera administered a flu vaccine at a resident’s home. Since the development of the EBAIS system, deaths from communicable diseases have fallen by ninety-four per cent.

As an ATAP, Herrera brought COVID vaccines to certain patients who were unable to travel to their local clinics. Because every resident is enrolled with an EBAIS, everyone was contacted individually about a vaccination appointment.

An elderly resident thanked Herrera after a visit. ATAPs are the point of contact between a national system and individual lives, seeing to the small details required for the broader demands of community health.


—- Tearsheet —-

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