Key points
- Costa Rica runs the Beveridge model: a single-payer national health service run by the Costa Rican Social Security Fund (CCSS), created in 1941, with the Ministry of Health responsible for overall stewardship.
- Coverage is universal on paper: social insurance is universal, solidary and compulsory under the Constitution and the CCSS Creation Law, and 93% of the population is covered for a core set of services — though a 'not insured' modality lets people with contributive capacity choose not to contribute.
- Care is delivered through EBAIS primary care teams — each serving around 1,000 households — with patients assigned by address and referred on to secondary care; there is no choice of provider or insurer.
- Households paid 24.1% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database), and voluntary private health insurance plays only a small role.
- Life expectancy at birth was 81.0 years in 2023, and health spending was 6.8% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: Costa Rica runs the Beveridge model: a single-payer national health service run by the Costa Rican Social Security Fund (CCSS), created in 1941, with the Ministry of Health responsible for overall stewardship. Coverage is universal on paper: social insurance is universal, solidary and compulsory under the Constitution and the CCSS Creation Law, and 93% of the population is covered for a core set of services — though a "not insured" modality lets people with contributive capacity choose not to contribute, and there is no formal mechanism to assure enrolment. Care is delivered through EBAIS primary care teams, each serving around 1,000 households, with patients assigned by address and referred on to secondary care. Households paid 24.1% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 81.0 years in 2023 — and healthy life expectancy 67.1 years — and health spending was 6.8% of GDP in 2024 (OECD Health at a Glance 2025; WHO Global Health Estimates, October 2026).
At a glance
| Item | Detail |
|---|---|
| Model | Beveridge — single-payer national health service (CCSS) |
| Who pays | Social insurance contributions to the CCSS, with the state insuring people without contributive capacity; government and compulsory schemes accounted for 67% of health spending in 2023 |
| Who delivers | The CCSS, through EBAIS primary care teams and a three-level network of hospitals; patients are assigned to an EBAIS by address and cannot access secondary care directly |
| What is free at the point of use | Emergency attention and primary healthcare, a universal right no one can be denied; people in the "not insured" modality are still entitled to emergency and primary care, and minors, pregnant women, retired people and people without contributive capacity are insured at the state's expense |
| Life expectancy at birth | 81.0 years (2023, OECD Health at a Glance 2025) |
| Health spending | 6.8% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | OECD Reviews of Health Systems: Costa Rica 2017 |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Costa Rica’s healthcare system is widely regarded as a success story. Its single-payer national health service was created in 1941 and has demonstrated considerable institutional stability since then. The Ministry of Health is responsible for overall stewardship of the health system, and for funding some public health services alongside the CCSS, such as vaccination. Healthcare services and health insurance are largely delegated to the Costa Rican Social Security Fund (CCSS), an autonomous institution with its own authorising law, created in 1941. The CCSS independently organises the financing, purchasing and provision of most healthcare services, and its mission is to provide health and some social care services in an integral form to the individual, the family and the community, as well as financial protection from catastrophic expense.
The CCSS provider network is organised by three distinct levels of care: primary, secondary and tertiary. At the time of the 2017 OECD review, the CCSS had 55,000 employees working across 29 hospitals, 103 health regions and 1,094 primary care units called EBAIS (Equipos Básicos de Atención Integral en Salud), providing 13.5 million consultations a year. Each EBAIS serves around 1,000 households, and each consists of at least one medical doctor, one nurse and one healthcare assistant, with social workers, dentists, laboratory technicians, pharmacists and nutritionists also supporting the clinic. Outpatient services, family planning and community medical services, health promotion and disease prevention are all delivered through the EBAIS, which can refer patients to higher levels of care when required. More than 1,000 EBAIS are present in every territory of the country. Secondary care is provided through 10 major clinics, 13 peripheral hospitals and 7 regional hospitals, and the highest specialisation is provided at tertiary level through 3 national general hospitals and 5 national specialised hospitals in San José.
Patients do not have any choice of provider or insurer. Individuals are assigned to an EBAIS according to their address, and EBAIS are networked with defined secondary care facilities. Patients cannot access secondary care directly, but must be referred from primary care. Around 80% of primary care presentations are resolved at that level, without referral to secondary care. The National Insurance Institute (INS) is a specialised agency covering healthcare needs arising from employment or traffic accidents, including hospitalisation and rehabilitation.
Who pays, and what people pay
Social insurance contributions to the CCSS pay for the system, with the state insuring people without contributive capacity: all minors under 18, pregnant women without family beneficiary coverage, the retired population, HIV patients from the non-contributive regime and people without contributive capacity are insured in charge of the state. Government and compulsory schemes accounted for 67% of health spending in 2023 (WHO Global Health Expenditure Database). What patients pay is substantial for a universal system: households paid 24.1% of health spending out of pocket in 2023. Voluntary private health insurance plays a small role, covering just 0.3% of the population and accounting for just 2% of total national expenditure on health at the time of the 2017 OECD review. Private providers play an increasingly important role: around 15% of primary care takes place through independent providers contracted by the CCSS.
What is free, and what is not
Free at the point of use: emergency attention and primary healthcare, a universal right no one can be denied. What is not free is the margin, and the gap is in enrolment as much as in charges: the existence of the “not insured” modality has allowed inhabitants with contributive capacity to choose not to contribute to social security, and there are no formal or legal mechanisms that the CCSS uses to assure that all citizens and residents, once they turn 18, will be enrolled and contribute, or stay permanently on the system. The “not insured” also include poor people lacking knowledge of their rights and undocumented migrants — though people within this modality still have the right to use secondary and tertiary services in an emergency. Access is also limited by hours: EBAIS only offer appointments in the morning and early afternoon. And the capacity behind the promise is thin: Costa Rica has 1.1 hospital beds per 1,000 population, the second-lowest in the OECD table after Mexico (1.0), against an OECD average of 4.2, and 7 CT, MRI and PET scanners per million people, against an OECD average of 51.
How it compares
Costa Rica spends 6.8% of GDP on health — below the OECD average of 9.3% — and $1,935 per person, below the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 81.0 years is 0.1 years below the OECD average of 81.1 years (OECD Health at a Glance 2025). Its distinguishing feature is the paradox in the figures: a single-payer system with near-universal access and strong primary care that still leaves households paying 24.1% of health spending out of pocket — while diabetes prevalence, at 23.2% of adults, is the highest in the OECD table, against an OECD average of 8.6%. The risk-factor picture is split: daily smoking at 6.2% and alcohol consumption at 3.4 litres per person are among the lowest in the OECD, but 51% of adults did not perform sufficient physical activity, against an OECD average of 30%. On quality, 99% of eligible children were vaccinated against DTP, higher than the OECD average, while only 22% of women were screened for breast cancer, less than half the OECD average of 55%. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is Costa Rican healthcare free?
Emergency attention and primary healthcare are a universal right no one can be denied, and care through the CCSS carries no bill at the point of use — but households still paid 24.1% of health spending out of pocket in 2023, and people in the "not insured" modality can choose not to contribute.
What is an EBAIS?
An Equipo Básico de Atención Integral en Salud: the integrated primary care team — at least one doctor, one nurse and one healthcare assistant — serving around 1,000 households, and the first point of contact for nearly all care in Costa Rica.
What is the CCSS?
The Caja Costarricense de Seguro Social (Costa Rican Social Security Fund): the autonomous institution created in 1941 that is the main insurer and provider of personal health services, independently organising financing, purchasing and provision.