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Table 1 Milestones in the making of Costa Rica’s national health system, 1941–2010

From: Promoting universal financial protection: a policy analysis of universal health coverage in Costa Rica (1940–2000)

Year

Policy measure

Coverage %

1941

CCSS is founded, providing health insurance for urban workers with wages up to $ 52.63 a month

3.0

1949

The new Constitution retains the three-fold symmetrical financing (employers, workers and government); management remains at CCSS

6.8

1954

Health insurance covers the spouse

11.9

1959

The salary ceiling rises to $ 149.25 a month

15.1

1961

Insurance coverage is declared universal with a ten year grace period

17.7

1962

Health insurance was extended to rural workers

20.3

1965

Health insurance was extended for the whole family

30.6

1970

Phasing out the salary cap

47.1

1971

Compulsory retirement insurance affiliation for all workers

51.5

1972

Health insurance for college students

53.8

1973

All private hospitals are transferred to CCSS; government pays health insurance for extreme poverty citizens

58.4

1974

Retirement insurance to all elderly poor

60.3

1975

Voluntary health insurance and retirement insurance coverage

59.6

1976

Retirees under special schemes become eligible for health insurance

61.8

1984

Insurance arrangement under presumptive income (for self-employed and farmers)

83.9

1995

Compulsory health insurance for retirement insurance retired workers

86.4

1996

Universal student health insurance

89.7

2001

Worker Protection Act grants new legal instruments against tax evasion and forces self-employed to join the health insurance scheme

87.5

2005

Health insurance for vulnerable people (poor, indigenous and rural poor) paid by Government

87.6

  1. Source: Adapted from Rodríguez A., Working Paper for Estado de la Nación, 2010 [9].