Strong Historical Commitment to Community Integration and New Innovations in Healthcare Integration: Costa Rican Primary Healthcare

Building upon a strong history of integrated primary healthcare in the 20th century, in 1995, Costa Rica restructured its primary healthcare system to one that is integrated with the community and among different levels of the healthcare system. Today, the community-based, geographically empaneled, multidisciplinary primary healthcare systems emphasizes preventive care alongside basic curative care.Most of today’s integrative practices were first developed in the 20th century when Costa Rica established critical antecedent healthcare models, which made today’s model possible, including Health Units, Hospital Without Walls, the Rural and Community Health Program, and Local Health Systems.Public health services and curative care are provided by a singular healthcare agency, enabling integration of preventive, primary, secondary, and tertiary care.Community health workers identify social determinants of health during home visits, stratify houses based on social risk, and refer patients to social/non-governmental services as needed.Networks of care provide clear referral pathways both toward specialty care and back to primary care after the referral is complete. This integration within healthcare system levels improves the wait times and more evenly distributes patients throughout the healthcare system.A proprietary electronic medical record system enables both community integration and vertical healthcare integration. The electronic medical record system holds the Family File, a social determinant-of-health survey filled out for each household by community health workers that helps to integrate social conditions into healthcare provision. The electronic medical record is also the same across all levels of care (primary, secondary, and tertiary), which enables each level to have a full understanding of the history, labs, radiology, and treatment plans from other levels.