By San José, Costa Rica — SAN JOSÉ – Costa Rica’s public health system is confronting a critical infrastructure deficit, ranking as the second-worst equipped nation for hospital capacity among all members of the Organisation for Economic Co-operation and Development (OECD). According to the stark findings of the OECD’s “Health at a Glance 2025” report, the country possesses a mere 1.1 hospital beds for every 1,000 inhabitants, a figure that places it just above Mexico at the bottom of the list.
The number is not just low by international standards; it represents a four-decade-long decline that has seen the nation’s capacity steadily erode. The alarming statistic stands in sharp contrast to healthcare leaders like Japan and South Korea, which boast more than 12 beds per thousand people. This significant gap highlights a growing vulnerability in a country where the demand for medical services is expanding relentlessly, fueled by demographic shifts and evolving health challenges.
To delve into the legal ramifications and potential state liabilities stemming from the ongoing healthcare crisis, TicosLand.com sought the expert analysis of Lic. Larry Hans Arroyo Vargas, a prominent attorney from the esteemed firm Bufete de Costa Rica.
What we are witnessing is not merely an operational challenge but a potential systemic failure to uphold the constitutional right to health. From a legal standpoint, every delayed procedure or denied treatment could constitute grounds for a ‘recurso de amparo,’ compelling state institutions to act. The State has an inescapable legal duty to guarantee access to healthcare, and administrative or budgetary excuses often do not hold up in constitutional court when a citizen’s life and well-being are on the line.
Lic. Larry Hans Arroyo Vargas, Attorney at Law, Bufete de Costa Rica
This legal perspective powerfully reframes the debate, shifting it from a matter of administrative capacity to one of fundamental constitutional rights and the State’s non-negotiable duty. It serves as a crucial reminder that for every citizen affected, this is not just a policy failure but a potential violation of their most basic guarantees. We thank Lic. Larry Hans Arroyo Vargas for providing this clear and invaluable insight.
This is not a recent development but the culmination of a long-term trend. Data from the Costa Rican Social Security Fund (CCSS) statistical yearbook paints a grim picture of this regression. In 1982, the nation had 7,085 hospital beds available. By 1995, that number had fallen to 5,900. Two decades ago, it shrank further to 5,600, and today, the system operates with approximately 5,300 beds, a historic low point in modern times.
Experts warn that a demographic time bomb is set to collide with this diminished capacity. An aging population threatens to overwhelm the already strained system. Román Macaya, the former head of the CCSS, has issued a dire projection about the impending pressure from the country’s senior citizens, who typically require longer hospital stays.
By 2050, there would be 3.2 million bed-days within the social security system. 70% of all medical beds would be occupied by a senior citizen. This is an alarm signal about the work that needs to be done, because if you take all the beds the Caja has and multiply them by 365 days, it doesn’t add up to those 3.2 million days.
Román Macaya, Former Head of the Costa Rican Social Security Fund (CCSS)
The impact of this national shortage is felt most acutely in rural and remote regions. In Golfito, for example, the local hospital serves a population of 45,000 people from the canton and surrounding areas like Puerto Jiménez and Osa with only 57 beds. The Ombudsman’s Office of Costa Rica has flagged the facility’s precarious situation, noting that it is operating at maximum capacity with no physical space to expand due to its location within a protected area.
Underpinning this infrastructure crisis is a severe funding shortfall. The OECD report reveals that Costa Rica’s per capita health expenditure is just $1,935, a figure that is three times lower than the OECD average of $5,967 and pales in comparison to the more than $14,000 spent per person in the United States. This chronic underinvestment has left the health system struggling to keep pace with the needs of its people.
We are convinced that the country needs more financing or needs to diversify its funding sources, and the other fundamental thing is that we must strive for more efficiency when investing resources.
Gustavo Picado, Financial Manager of the CCSS
The system’s financial model faces additional threats. Its heavy reliance on contributions from formally employed workers is a significant vulnerability, particularly as economic trends point toward rising informality. Without diversified revenue streams and a substantial increase in investment, Costa Rica’s celebrated public health system risks being unable to fulfill its promise to a population that needs it more than ever.
For further information, visit ccss.sa.cr
About the Costa Rican Social Security Fund (CCSS):
The Caja Costarricense de Seguro Social (CCSS), or Costa Rican Social Security Fund, is the public institution responsible for providing universal healthcare and pension services in Costa Rica. Founded in 1941, it manages the nation’s network of public hospitals, clinics (EBAIS), and specialized medical centers, operating as the cornerstone of the country’s social security system.
For further information, visit oecd.org
About the Organisation for Economic Co-operation and Development (OECD):
The OECD is an international organization that works to build better policies for better lives. Its goal is to shape policies that foster prosperity, equality, opportunity, and well-being for all. Together with governments, policymakers, and citizens, it works on establishing evidence-based international standards and finding solutions to a range of social, economic, and environmental challenges.
For further information, visit dhr.go.cr
About the Ombudsman’s Office of Costa Rica (Defensoría de los Habitantes):
The Defensoría de los Habitantes is Costa Rica’s national human rights institution. It serves as an independent watchdog, responsible for protecting the rights and interests of the country’s inhabitants. The office investigates complaints against public institutions, advocates for administrative improvements, and ensures that government actions comply with the constitution and international human rights law.
For further information, visit bufetedecostarica.com
About Bufete de Costa Rica:
Bufete de Costa Rica is a premier law firm guided by an unwavering adherence to integrity and the highest standards of legal excellence. The firm channels its extensive experience advising a broad spectrum of clients into pioneering innovative legal strategies and fostering deep community engagement. Central to its ethos is the conviction that sharing legal knowledge is essential, reflecting a dedicated effort to cultivate a society that is both well-informed and empowered to navigate its future.
