The life expectancy of Costa Ricans is the highest in Latin America—and it rivals that of the majority of developed countries. Costa Rica, officials say, is “healthy without being wealthy.” In large part, this is due to a series of government decisions. The authors of The Ticos (Biesanz 1999), a groundbreaking sociological study, attribute the longevity of locals to  “years of government spending on clean piped water, vaccinations, nutrition and health education as well as to a health insurance program that covers almost everyone.”

This last point is key. Since the establishment of the Social Security system in 1941, nearly all Costa Ricans have enjoyed the benefits of a free, universal health care system that offers cradle-to-grave medical services. The Washington Times calls Costa Rica’s Social Security system “probably the most prestigious of Costa Rica’s institutions and the best in the entire hemisphere,” noting a nearly 100% coverage rate. Analyst Jorge Nowalski, in “Economic, Labor and Social Asymmetries in Central America,” notes that only Panama—with about 80% coverage—approaches Costa Rica’s rate of coverage. Nowalski also points out that Nicaragua, El Salvador, Honduras, and Guatemala cover barely half of their citizens.

Healthcare professionals are highly trained; quite a few of them received their educations in the United States and Europe; you will also find that many doctors and dentists speak English. Public hospitals provide emergency care to everyone, including foreigners, regardless of their ability to pay. (While many public hospitals project a somewhat grim ambiance—with facilities that are a bit the worse for wear—the country has a number of excellent, private hospitals that are clean, pleasant, equipped with state-of-the-art technology, and internationally certified.)

It should be pointed out that the public health care system is far from perfect. The system is strapped for cash, with the result that you often have to wait hours to see a physician; and, patients are often forced to schedule surgeries and other procedures—even for life threatening maladies—months in advance. A number of investigative pieces by journalists have stated that wealthier patients frequently bribe their way to the top of the scheduling list for surgeries.

As you might expect, many Costa Ricans and most foreign residents choose to go to private clinics and hospitals, which generally provide higher quality care than state-run institutions. CIMA, Clinica Bíblica, and Clínica Católica, all located in San José or nearby, are three excellent private hospitals. But what about hospitals and other heath care services outside of San José, particularly at beach locations? A number of beach towns and other rural areas already have hospitals, and several new hospitals are under construction at the time of writing this book, including a rather large hospital facility south of Dominical, on the Pacific coast. CIMA and Clínica Bíblica, the two largest private hospitals in the country, both have plans to build along coastal areas; CIMA has plans to build in Liberia in order to serve patients in the province of Guanacaste. Clínica Bíblica, a recipient of donated land near Tambor (on the Nicoya Peninsula) that is designated for hospital use only, will begin construction as soon as it judges that there is sufficient demand for hospital services in the area. People living in remote areas that are without hospital services do have at their disposal a helicopter ambulance service that can very quickly transfer patients to San José.

Costs for health care services at private hospitals are substantially lower than in North America and Europe. Using a very imprecise yardstick, you should count on health services here costing about 25% of what you would pay in the U.S. A visit with a general practitioner at Clínica Biblica, for example, will cost you about $35; the cost for consultation with a specialist most likely won’t exceed $50. Although the costs for dental services vary greatly from dentist to dentist, there are a number of excellent, very affordable dentists in the country. Most dentists of reputable standing charge less than $75 for a check up and cleaning; cavity fillings should cost you less than $100.

For some time now, Costa Rican plastic surgeons (and dentists) have been effectively marketing their services to foreign customers. Medical tourism offers a number of advantages. First, the customer pays substantially less than in their home country; second, they spend their recovery time amid beautiful surroundings, far removed from the stressful pace of day-to-day life; finally, some want to hide the unsightly signs of plastic surgery from family and friends back home—they can let the scars heal as they lounge by a secluded swimming pool.

A thorough discussion of health care insurance is beyond the scope of this book. Before being eligible to receive services from public hospitals, you must first establish Costa Rican residency status (check with a local lawyer for additional requirements). Anyone in Costa Rica, whether a legal resident or not, is eligible to purchase health insurance from INS, the government controlled institution that is currently the sole legal provider of health insurance within the country; INS insurance is quite affordable—depending on where you fall on the actuarial tables—but INS policies often carry a large deductible (and a very low maximum payment). Many people opt to buy health insurance from insurance providers located in other countries that sell policies that will cover you anywhere in the world; deluxe insurance policies also provide for air transport to the U.S. should you require attention at a hospital there. The recent passage of CAFTA (Central American Free Trade Agreement) likely spells the end to the INS monopoly, and you should expect to see a wide range of new insurance providers arriving in the country to set up shop.

A lot of people are curious about whether they might incur any special health risks by virtue of living in Costa Rica. The short answer is no. Water quality is excellent; health care services are of very high standards; and life expectancy ranks with that of the industrialized world. It is true that the country is home to about 17 species of venomous snake, but you’re unlikely to ever encounter one. Mosquito-carried diseases, mainly malaria and dengue, are reported for Costa Rica, but they generally occur among small populations of people living in quite remote areas of the country. It’s also true that the rate of stomach cancer in Costa Rica is one of the highest in the world, but that should by no means keep you from moving here. First, no one has proved that the cause is due to environmental factors (genetics could be involved); second, even if researchers were to demonstrate a link to an environmental factor, people who move to the country later in life would not have been subjected to its long-term, cumulative effects. Third, some researchers speculate that there might be a link to the consumption of certain kinds of food; in that case, it’s very possible that your food consumption patterns would prove to be quite different from that of the high risk group. Finally, looking at the issue from another perspective, by moving here, you simultaneously leave behind a country with its own set of unique health risks. One last word on health and safety issues: A World Bank report (October, 2006) states that Latin America and the Caribbean has more traffic deaths per capita than any other region of the world. Each year, about 122,000 people lose their lives on the road. In Costa Rica, the worst traffic conditions (and driving habits) are found in the Central Valley on windy roads that traverse high mountains. Once safely ensconced in your beach-town home, however, your biggest driving challenge will be to avoid the potholes. In general, whether driving in Costa Rica or anywhere else, drive at safe speeds, drive defensively, wear your seat belt, and avoid crossing high mountain passes in bad weather or at night.