A Trip to the Doctor

Expats in Costa Rica have a number of options when it comes to medical care. The most direct (and expensive) option is to just go to a private hospital or clinic. Prices will be lower than in the USA but they aren’t dirt cheap.

Another option is to get private insurance through INS. I can’t say too much about that because I am not a part of it. From what I have heard, it’s decent as long as you have no preexisting conditions. I do (nothing serious, dear… but enough to disqualify me).

My own primary source of medical care is the public health system here, known as the CAJA. It’s a system of hospitals, clinics and pharmacies that treat you at no cost per visit or medicine.

It costs me well under $1000 a year and I probably get that much back in free medication. It’s a good deal for me. CAJA is theoretically only available to legal residents but like most things in Costa Rica it is ‘fungible.’

There are times and situations where I will see a private doctor, primarily due to some of the shortcomings of the CAJA system. Appointments to see some types of specialists or take certain tests can be very long, and those who can afford it often choose to go to one of the private hospitals or clinics. Also, certain types of drugs require a prescription that the CAJA will not (can not, they say) write, such as for Valium or other psychotropic drugs. There are many medicines the CAJA does not carry, but you can get most over the counter at the local pharmacies.

Anyhow, my primary care doctor made an appointment for me with a internal medicine doctor, and 5 or 6 months later I went to the appointment. I got the time wrong on my appointment but the doctor made a little room for me and I ended up needing some tests. This is where it gets interesting, I guess.

Before I go any further, I should mention that although most of the doctors can speak at least SOME English, the clerks and others you’ll have to deal with are a different story. My Spanish is just barely good enough and I am just cheap enough not to pay a translator to come with me, but if you aren’t nearly fluent, you may find dealing with the CAJA very difficult if not impossible. Many of the private hospitals and clinics love Gringos (well, their money at least) and will have receptionists who speak English.

Anyway, the first doctor wrote me up a referral and I took it to the window to make the referral appointment for a couple of tests. After doing some stuff whose purpose I don’t understand, the woman in the window finally got across the point that I needed to take my paperwork across the street to the hospital (Calderon Guardia) and go to the xxxx department. She gave me directions that I might have understood if I were a Tico, but I figured I would do what I usually do, when I get close I ask somebody for more directions. This worked reasonably well to get to destination one, which was the place where they do the actual tests. When I got there I was glad to see there was no line, although there were a ton of people sitting in the waiting room.

The young woman in the window did her best to be helpful, but I had quite a bit of difficulty understanding just what I was supposed to do next. With a little help from some bystanders I was finally able to understand that I needed to go over to yet another building and another window to ask for my records to be sent to the xxxx department before the tests, which would take place in a week. They only performed those tests on Mondays, I was told, and my guess it is because there is some equipment being shared between hospitals and clinics.

So I was off to the next building and window, and once again after a few stops to ask for directions, I was able to find the window. There was a line this time, not too bad, and eventually I gave the paper to the clerk, and he asked me a lot of questions I understood and answered, but couldn’t see the purpose of.

My father’s first name, for example. My father passed away years ago and I don’t see what knowing his first name accomplishes, but I was there to get something done, not understand the Tico mind.

Good thing, too, as I won’t live forever even with the best medical care in the universe. At any rate, I got through the gauntlet and I’m scheduled for my tests next Monday.

Just as a side note, Costa Rica does NOT have universal care, though it does have a socialized health care system in the CAJA. Those without a formal job are not covered unless they are making enough (selling pirated DVDs perhaps) to afford it and do join it voluntarily. Emergency services are available at emergency rooms (long lines, but that’s common even in the USA) but that’s no help for somebody who needs cancer treatment or any number of other types of treatment.

The system works well enough for me. The rare occasions I need something done in a hurry that isn’t readily available through the CAJA, I go private. And I speak decent Spanish. It’s not first-rate in every way, but most ailments don’t require state-of-the-art equipment and facilities. A very frugal person could live on the difference between what I was paying in the USA for health care (insurance and co-pays) and what I pay here. All in all, I am glad the CAJA is there, long lines and all.

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  1. We just recently received the last of our residency resolutions (3 of them issued over 7 months!) and are looking forward to getting our cedulas and joining the Caja. Thanks for this man-on-the-spot article about the general experience you have with the system. My expectations are not high, but between Caja and the private network it all seems quite adequate (unless I come down with some rare thing that only Dr. House could solve!). You are absolutely right that the difference in health care costs here and just what one has to pay for insurance/co-pays/meds in the States is huge.

    • I think you can go get enrolled with just your resolutions. In fact as of the first of May immigration wasn't making new cedula appointments for people who had not enrolled, and they made an official ruling that you were required to enroll between the resolution and cedula issue.

      If you already got your cedula appointment, then I doubt you would be affected by the new rule, but you can certainly enroll now if you wish.

      • We just got our cedula appointment a couple of days ago. Probably we were grandfathered in under the old rules since we applied so long ago. That's certainly true of the income requirement for pensionado, which we could not have met under the new limits.

  2. Asking your father or mother's name is a good way to identify a Costa Rica person as this information is really easy to lookup in the records of the civil registry and especially when many people have names like Maria Jesus or Juan Carlos.

    You would think that cedula numbers should be a positive identifier, however about half the time I go to the clinic they put me in the system with the name of a tico that believe or not is similar to this gringo.

    I think they just don't like the resident cedula number, which is longer than the citizen cedula, and which in my case is going to hopefully change in about 18 months.