Q(OP-ED) — In principle Copays make sense. A fundamental law of Economics is that if something is free, like doctor visits or operations in hospitals, people will consume them until they are completely sated.
In any free healthcare system if missing a scheduled appointment costs nothing, patients will miss them if it suits them.
But refinements are needed. Copays should be graduated, so that they cost the rich more than the poor.
If the copays are set too high, the poor will be deterred from seeking necessary and preventative healthcare.
Low copays are trivial to the rich.
Other issues in Costa Rican Healthcare
- Many doctors work part-time in Caja and have private practices Getting priority for their private patients hits the waiting lists for the poor.
Newcomers from the US and other countries get instant access to benefits. The Costa Rican system is founded on the egalitarian principle that all who join get the same benefits.
In practice, this is far from egalitarian. Immigrants from rich countries get instant benefits without any screening of pre-existing conditions.
This leads to Costa Rica being a great place for older people to come and have their hip replacements etc done for free.
For poor immigrants, this may be a safer and easier country for natal care.
These things bump locals, who may have been paying in all their lives, from the line.
- The more educated know how to work the system and the wealthy know how to use their contacts. This is true worldwide. It disadvantages the less educated and poorer Costa Ricans.
Deciding which treatments should be funded becomes a problem. Is cosmetic surgery more important than a hip replacement? It might be, if a child has a harelip and the need for hip surgery is not an acute case.
Complex matters of cost effectiveness, pain and likely lifespan of patients need assessing.
Medical practitioners have a big say in the need for treatment. Many are specialists. They lobby for priority.
There are many vested interests in preventing serious reform
In all societies those who benefit from the status quo tend to dominate the legislative and administration.
This is true here. We are unlikely to see much change.
Charging a copay, with less for the poor would be a first step.