A Crazy Little Place Called Costa Rica's Healthcare System

Today I had to make my quarterly appointment with my doctor in my medical district in Costa Rica. It's always an exhausting process for me because despite having used Duolingo for four years straight, I still have trouble understanding what people are saying unless they slow. the. fuck. down. But I've been going to this clinic for four years now, and I know what to expect for the most part. I wish I could take care of all my health needs through this clinic because I know what to expect, but this is just the first step of the weirdly bureaucratic Costa Rica healthcare system.

The picture above is EBAIS (Equipos Básicos de Atención Integral en Salud), but it's where I visit four times a year to make sure my prescriptions remain current. My husband pays into the CAJA (Caja Costarricense de Seguro Social) each month. I don't think it's much, and besides that, all our prescriptions* and appointments are free. It's a very pleasant way of living if you are completely healthy and require no advanced medical care. I was surprised today because I didn't see the doctor I normally see, who I don't care for much anyway, and was assigned a new doctor. I panicked because of the language barrier, but really these meetings are just a formality to tell you that everything is normal. Your blood is not filled with worms. Your pee gives no indication of the quantity of cheap PriceSmart whisky you consume.

*(I mention above that prescriptions are free, but I want to share two thoughts. Some common medications are not available here at all. I suffer from insomnia and in the United States, I took Trazadone which was really great. There is nothing like that here. Also, there are medications available at farmacias that Caja doesn't cover. You have to pay for these out of pocket. Some you need a doctor's prescription for and some you don't.)

If there is a problem, you are advanced to an internist and that's where things start to get complicated. I have nothing negative to say about the doctors themselves, but the process after the internist stage is a little:

The internist herself is at another larger clinic for the region, and there are many things you can have done there such as X-Rays, and I suppose other things. But mainly I go there Moreno Cañas twice a year to meet with her. And oh boy is it trouble if you have to go beyond that, which I do because of chronic pain, depression, anxiety, diverticulitis, and other realities of living with a mental disability.

You can't just go to the next place, Hospital San Juan de Dios which is in San José and has been around this long, and make an appointment. You have to go to Hospital San Juan de Dios to make an appointment for getting an appointment. That's two trips to get an appointment with, say, a brain surgeon. But you don't always get the appointment on that second trip. You might not meet the criteria to see the brain surgeon so you are either sent back to your recommending doctor or have to give more blood for tests. There could be all kinds of things that hold up you getting that second appointment. But you'll eventually get it.

For next year.

Costa Rica is constantly named the best of happiest place to live in either The Americas or Central America, but I dare say, Costa Rica is the Taylor Swift of countries. By which I mean, it's all marketing and no substance. There are parts of Costa Rica that are astonishingly beautiful and you really don't want to leave, but you don't want to take too close a look either. And I often wonder what selection of very wealthy white United States expats they survey to determine that Costa Rica is happier than, say, Disneyland.

If you live here and you are not in an expensive bungalow or mansion less than a kilometer from the beach, you are probably living in an area where local Ticos (citizens of Costa Rica) live. If you are living where the locals live, then you see a much different country. Polluted waterways, families only able to afford their own country because three generations live in the same home, roads that are packed with smog inducing vehicles that make a 40 kilometer journey stretch into 3 hours. And if you are a wealthy expat, you most likely get private insurance and can afford to forego Caja, even if you have to pay for it.

I've had a headache that varies in pain since Christmas Eve 2021. I know this because I remember exactly when it hit and what I was doing: enjoying opening gifts with my husband and having a most expensive bottle of whisky he gifted me.

At the time, I still wasn't a resident and didn't qualify for Caja, but I did what I could to manage it. Once I qualified for Caja in 2022, I went to the doctor and my brain was my main concern. When last I had an MRI in 2018, I was diagnosed with two brain aneurysms. At the time, they were deemed non-life threatening. I wasn't bleeding out of my nose like a telepath or telekinetic, so I knew it probably wasn't super severe (I suspect it's stress induced).

Once my local clinic took me seriously about my head, sometime in 2024, I was sent to my regional internist in late 2024. By the time I got an appointment for a neurologist, it was for January of 2026. When I went to that appointment, the very pleasant doctor asked where my MRIs were. Unbeknownst to me, I was supposed to receive a call from the lab where MRIs are performed 2 months before my appointment with the neurologist. I never received that call.

His next available appointment is for March 2027, and I have to hope that I receive the call from the MRI lab in order to have that done so he can examine my brain just to tell me it's most likely stress related because my two tiny aneurysms wouldn't be causing that much pain.

At the same time I made the appointment in late 2024 to see the neurologist in January of 2026, I also made an appointment with a physical therapist which won't happen until July of 2026. Over a year and a half wait.

For the record, I have no problem with socialized medicine. The doctors here are top notch. They seem to care way more than most of the doctors I ever saw in the United States, but Costa Rica is so busy spending money on marketing itself as a place with blue zones where you'll live to be 119 that they fail to invest in vital infrastructure citizens and residents of the country require. I could write another article about the public transportation system or how Costa Rica's tariffs and sales taxes are punishing to the people who live here full time and do not have a bank account with less than 2 zeros after a number.

It's because of this, and other annoyances that we decided to leave, but the dangerous part about being an expat is that you might get stuck being an expat where you are. I have no desire, nor could I afford, to move back to the United States, but while rent would be cheaper in Spain, everything else is ludicrously less expensive, but you have to have a certain threshold of money to get residency there, and we are about $30K short.

So now, I just wait for my next appointment. I will see my district doctor 3 more times before I see my neurologist and my internist twice. They feel for me. I can see it on their faces, but they know as well that healthcare is a waiting game in this paradise... if it doesn't kill you first.