Primary Health Care That Works: The Costa Rican Experience

Madeline Pesec; Hannah L Ratcliffe; Ami Karlage; Lisa R Hirschhorn; Atul Gawande; Asaf Bitton

doi:10.1377/hlthaff.2016.1319

Primary Health Care That Works: The Costa Rican Experience

Health Aff (Millwood). 2017 Mar 1;36(3):531-538. doi: 10.1377/hlthaff.2016.1319.

Authors

Madeline Pesec¹, Hannah L Ratcliffe², Ami Karlage³, Lisa R Hirschhorn⁴, Atul Gawande⁵, Asaf Bitton⁶

Affiliations

¹ Madeline Pesec (madeline_pesec@brown.edu) is a medical student at the Warren Alpert Medical School at Brown University, in Providence, Rhode Island, and a primary health care intern at Ariadne Labs, a joint center of Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
² Hannah L. Ratcliffe is a primary health care research specialist at Ariadne Labs.
³ Ami Karlage is a research assistant at Ariadne Labs.
⁴ Lisa R. Hirschhorn is a professor of medical social sciences at the Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and an affiliate member at Ariadne Labs.
⁵ Atul Gawande is executive director of Ariadne Labs, a general and endocrine surgeon at Brigham and Women's Hospital, a professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, and the Samuel O. Thier Professor of Surgery at Harvard Medical School.
⁶ Asaf Bitton is director of primary health care at Ariadne Labs, an assistant professor of medicine in the Division of General Medicine at Brigham and Women's Hospital, and an assistant professor of health care policy at Harvard Medical School.

PMID: 28264956
DOI: 10.1377/hlthaff.2016.1319

Abstract

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Keywords: Costa Rica; Empanelment; Multidisciplinary Teams; Population Health Management; Primary Care.

Project HOPE—The People-to-People Health Foundation, Inc.

MeSH terms

Costa Rica
Delivery of Health Care / organization & administration*
Developing Countries
Health Care Reform
Humans
Organizational Case Studies
Organizational Innovation
Patient Care Team / organization & administration
Primary Health Care / organization & administration*
Universal Health Insurance*