Improved primary care system in Costa Rica linked with reduction in death rate


December 12, 2023 – In areas where Costa Rica opened primary care health centers offering improved and expanded care, the mortality rate fell by 13% over a nine-year period, according to a new study.

The study, published December 1 in the Journal of Health Economics, was co-authored by experts from INCAE Business School in Costa Rica and Madeline Pesec, a research fellow at Ariadne Labs, a joint center for health innovation at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health.

Although it has long been known that strong primary health care (PHC) is essential to well-functioning health care systems and to improving health outcomes, it has been challenging to study its impacts because PHC reforms are often intertwined with other health and economic reforms, which can cloud results, according to Asaf Bitton, executive director of Ariadne Labs.

In the new study, the researchers were able to take advantage of a natural experiment. They looked at the rollout of the Costa Rican PHC intervention of 1995, when the nation’s predominant health care provider, the Costa Rican Social Security Fund (CCSS), gradually consolidated, improved, and expanded its PHC system. By 2019, CCSS had created 106 Health Areas (HAs)—clinics staffed with multidisciplinary health care teams, with Costa Ricans assigned to specific HAs based on where they lived.

Analyzing mortality data from 1990 to 2011, the researchers found that, in the nine years following the opening of an HA, there was an associated 13% reduction in the mortality rate in the patient population assigned to that HA. The effect was strongest among the elderly and for those with noncommunicable diseases such as cardiovascular disease. In addition, the study found that, as HAs opened, more people sought care at primary care clinics and fewer sought care at emergency rooms.

The new paper “provides further evidence of the profound effect primary health care can have on health outcomes,” said Bitton.

Read the study: The effect of primary healthcare on mortality: Evidence from Costa Rica

Photo: iStock/Luciano_Marques