Costa Rica’s EBAIS (Equipos Básicos de Atención Integral de Salud) are multidisciplinary teams that provide holistic and preventative health services across the country. Since 1995, the EBAIS model has sought to extend the provision of primary care to all and improve health outcomes through a focus on prevention. It has proven to help increase life expectancy and reduce health inequities in the country. There are more than 1,000 EBAIS teams in the country (about one EBAIS per 4,000 people).1
EBAIS clinics are distributed across the country to provide primary health care services to communities, ensuring that all Costa Ricans have access to healthcare. Each clinic is run by a multidisciplinary team that includes a nurse, a technical assistant (ATAP), a medical data clerk and a pharmacist. Nurses and physicians provide counseling, treatment, and monitoring, while the pharmacist facilitates access to medication, and clerks record data, and report on quality of care to the Social Security Agency (Caja Costarricense de Seguridad Social, CCSS), the entity in charge of the program.2
Services provided by EBAIS cover different needs, including disease treatment, vaccination campaigns, and the detection and monitoring of risk groups at all ages. EBAIS teams also engage in awareness-raising and education on disease prevention, as well as vaccination campaigns and home visits.
Key to the EBAIS success is a community-based approach, where the EBAIS team closely monitors the health conditions of the area.3 All citizens are assigned to one EBAIS and are entitled to one yearly wellness visit, or more depending on their health condition. Payments for any services are paused for unemployed patients, and are provided at lower prices than market rate.4 Additional support from social workers or specialized doctors can also be coordinated through the EBAIS,5 though for more serious health treatments, the EBAIS team refers patients to the nearest hospital.6
The EBAIS model was a result of the reform of Costa Rica’s primary healthcare system in the early 1990s, following dissatisfaction with the previous healthcare system which was inefficient, costly, and was not available in the most remote areas.7 The first EBAIS clinic was established in February 1995, and early implementation of clinics focused on rural areas with the lowest income and with the least access to healthcare services, and then extended to wealthier urban populations.
The number of EBAIS had reached 400 by 1998, and almost 900 by 2005.8 In 2016, there were 1041 EBAIS across the country, which is equivalent to one EBAIS per 1,000 households or approximately 4,000 patients.
At the time of the 1995 reforms, Costa Rica raised USD 123 million, including USD 47 million from the Inter-American Development Bank, a USD 22 million loan from the World Bank for 17 years, and additional funding from donors such as the Governments of Spain and Sweden. Costa Rican funds were managed by the CCSS, financed by contributions of employees, employers and the Government via a payroll tax. By 2022, the total health budget amounted to CRC 5,700 billion (USD 10.5 billion), almost two-thirds of which is dedicated to public healthcare services, notably the EBAIS.9
Costa Rica’s primary healthcare system is considered one of the best models in the world. In just the first five years, EBAIS clinics increased healthcare coverage from 64 percent to 79 percent,10 and by 2017, over 93 percent of the population had access to primary healthcare in Costa Rica.11 A study also demonstrated greater declines in the proportion of underserved communities (based on distance to medical facilities and ratio of doctors to people) in pioneering EBAIS areas (from 30 percent to 22 percent) compared to areas where EBAIS was implemented later (where the proportion of underserved people slightly increased from 7 percent to 9 percent) in the first five years of the program.12 It is estimated that the EBAIS system granted a 70 percent return on the World Bank’s investment.13
The EBAIS preventive approach and healthcare network has contributed to Costa Rica having the lowest rates of adult mortality from non-communicable diseases among lower-middle income countries.14 The rate of communicable diseases decreased from 65 cases per 100,000 people to 4.2 in the first 15 years of the EBAIS.15 Life expectancy in Costa Rica, at 79.28 years in 2020, is higher than that of many wealthier countries, including the United States.16 The testing, awareness-raising, and vaccination efforts of EBAIS during the COVID-19 pandemic resulted in Costa Rica’s extremely low levels of COVID-19-related deaths.17
Criticisms of the system include the impact of limited daily hours of EBAIS operation on working populations and the increasingly long wait times for services in recent years.18
Costa Rica’s Health Care Access and Quality (HAQ) Index increased by 10 percent from 1990, reaching 72.9 in 2015 (11 points higher than the average for Latin America and the Caribbean)19 and it has the 41st highest Universal Health Coverage Index in 2019.20
- 1. Cuccia, Luca et al. “ Costa Rica’s Health Care Reform: Impact and Success of the EBAIS Model” McGill Journal of Global Health vol. VIII (2019 Spring): https://www.presidencia.go.cr/comunicados/2016/06/ccss-alcanza-cobertura-de-1-041-ebais-en-todo-el-pais/.
- 2. OECD, “Estudios de la OCDE sobre los Sistemas de Salud. Costa Rica: Evaluación y Recomendaciones,” February 2017, https://www.oecd.org/els/health-systems/Estudios-OCDE-sobre-los-Sistemas-de-Salud_Costa-Rica_Evaluaci%C3%B3n-y-Recomendaciones.pdf.
- 3. Gawande, Atul. “Costa Ricans Live Longer than We Do. What’s the Secret?” The New Yorker, August 30, 2021 Issue, https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret.
- 4. Cuccia et al., 2019.
- 5. Rodríguez Herrera, Adolfo,“Reformas de salud y nuevos modelos de atención primaria en América Central.” Desempeño económico y política social en América Latina y el Caribe: los retos de la equidad, el desarrollo y la ciudadanía. Economic Comission for Latin America and the Caribbean (ECLAC), 2005, https://repositorio.cepal.org/handle/11362/1958.
- 6. Cuccia et al., 2019.
- 7. Ibid.
- 8. Rodríguez Herrera, 2005.
- 9. OECD, 2017.
- 10. Cuccia et al., 2019.
- 11. Rosero-Bixby, Luis, “Spatial access to healthcare in Costa Rica and its equity: a GIS-based study., Soc Sci Med, April 2004, vol 58(7) doi: 10.1016/S0277-9536(03)00322-8. PMID: 14759675.
- 12. Cuccia et al., 2019.
- 13. BBC News Mundo, “Coronavirus en Costa Rica: las claves de la efectiva estrategia del país centroamericano para controlar la pandemia,” BBC, May 6 2020, https://www.bbc.com/mundo/noticias-52558490.
- 14. Ibid.
- 15. "Life expectancy at birth, total (years)” The World Bank Data, https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=CR.
- 16. BBC News Mundo, 2020.
- 17. Valerio, Melissa. “Listas de espera de la CCSS roban años de vida a población costarricense,” Sinart Digital, 16 November 2022, https://costaricamedios.cr/2022/11/16/listas-de-espera-de-la-ccss-roban-anos-de-vida-a-poblacion-costarricense.
- 18. Healthcare Access and Quality Index. Our World in Data, https://ourworldindata.org/grapher/healthcare-access-and-quality-index?tab=chart&country=~CRI.
- 19. Universal Health Coverage Index. Our World in Data. https://ourworldindata.org/grapher/universal-health-coverage-index?country=~PAN
- 20. "Costa Rican doctor holding heart with flag of Costa Rica background," ©Adobe Stock/millaf