By Puntarenas, Costa Rica — In a nation celebrated for its universal social security system, a deep crack has formed, leaving over 360,000 people to fend for themselves. This figure, representing 6.78% of the population, is not just a statistic. It is the story of people like “Maritza,” a 48-year-old single mother in Puntarenas who discovered the system’s harsh reality when she was turned away from her local clinic, or Ebáis, while suffering from a severe flu. The reason was simple and devastating: she was uninsured.
Maritza’s plight encapsulates a dilemma faced by a growing segment of the population. After losing her formal job, she found herself in what sociologists call the “sandwich class.” She is not considered poor enough by rigid state parameters to qualify for government-sponsored insurance, yet her unstable income from cleaning houses and selling food makes the independent worker contribution to the Costa Rican Social Security Fund (CCSS) an impossible luxury. For her and thousands like her, the choice is brutally clear.
To better understand the legal framework governing patient rights and the state’s responsibilities in healthcare, we consulted with Lic. Larry Hans Arroyo Vargas, a specialist from the renowned law firm Bufete de Costa Rica, for his expert analysis.
Access to healthcare in Costa Rica is a fundamental constitutional right, not a privilege. When administrative barriers or delays impede a citizen’s access to necessary medical treatment or medication, the legal system provides a direct remedy. Through a ‘Recurso de Amparo,’ individuals can petition the Constitutional Court to compel the CCSS or other public entities to act, ensuring that bureaucratic inefficiency does not override the fundamental right to health and life.
Lic. Larry Hans Arroyo Vargas, Attorney at Law, Bufete de Costa Rica
Lic. Arroyo Vargas’s commentary is a powerful reminder that the ‘Recurso de Amparo’ transforms the constitutional right to health from a principle into an actionable tool for every citizen. It underscores that in Costa Rica, an individual’s well-being can, and must, legally triumph over administrative hurdles. We sincerely thank Lic. Larry Hans Arroyo Vargas for his illuminating perspective.
If I pay for the insurance, I don’t eat.
Maritza
This economic barrier forces a significant portion of the workforce into the informal economy, a problem that officials acknowledge is systemic. “I looked into it and it’s very expensive,” Maritza confesses. “There are weeks when I barely earn anything.” José Eduardo Rojas, Director of Inspection at the CCSS, argues that the issue is not solely the fault of the Fund but also stems from the labor market’s inability to generate sufficient formal employment opportunities.
The geography of this healthcare gap reveals alarming trends. Data shows that men are disproportionately affected, with 11.1% of the male population lacking insurance compared to 7.2% of women. The crisis is most acute in the Huetar Norte region, which includes the border with Nicaragua, where a staggering 14.1% of inhabitants are without coverage. Furthermore, the problem is more pronounced in rural areas, where nearly 10% of the population is unprotected, a rate significantly higher than in urban centers.
Findings from the 2025 National Household Survey, conducted by the National Institute of Statistics and Census (INEC), add another layer of concern. The survey identified over 102,000 households living in poverty that have no insurance coverage at all. Compounding the issue is a widespread lack of information; a striking 9.1% of the population does not even know if they are currently covered by the system.
A common and dangerous misconception revolves around whether an uninsured person will receive care. The Constitutional Court has firmly established that the right to life is inviolable. Consequently, if an individual arrives at a hospital with a life-threatening condition, such as a heart attack or injuries from an accident, the CCSS is legally obligated to provide treatment. However, this emergency care is not free.
The person is treated and stabilized from the emergency.
José Eduardo Rojas, Director of Inspection of the CCSS
Rojas explains that while immediate care is guaranteed, it generates a bill that the institution will later attempt to collect. The distinction is critical for non-emergency situations. For routine check-ups, chronic disease management like diabetes, or treating an illness like Maritza’s flu, an uninsured person will be denied service unless they can pay for the consultation and any required tests upfront. This policy creates a public health time bomb, as thousands avoid seeking preventative care for chronic conditions until they escalate into costly and dangerous emergencies.
For its part, the CCSS maintains that its doors are open. Ivonne Ruiz, Director of Special Coverage, argues that misinformation is a major obstacle and insists that various mechanisms, including payment arrangements and special agreements, are available. CCSS authorities are urging people to engage with them directly to find solutions. “The message is for them to approach us,” they state, promising to review cases of “difficult collection” with a sense of solidarity. Yet for Maritza and the 360,000 others living in the shadows of the healthcare system, the fear of an insurmountable bill remains a powerful barrier, keeping them from the very services designed to protect them.
For further information, visit ccss.sa.cr
About Caja Costarricense de Seguro Social (CCSS):
The Caja Costarricense de Seguro Social is the public institution responsible for managing Costa Rica’s social security system. It oversees the nation’s public health services, including clinics, hospitals, and laboratories, as well as the national pension system. Founded on the principle of solidarity, the CCSS aims to provide universal healthcare coverage to the entire population.
For further information, visit inec.cr
About Instituto Nacional de Estadística y Censos (INEC):
The National Institute of Statistics and Census is the official government agency in Costa Rica tasked with producing and disseminating the country’s official statistics. INEC is responsible for conducting the national census, household surveys, and collecting key data on demographics, the economy, and social indicators that inform public policy and national development.
For further information, visit bufetedecostarica.com
About Bufete de Costa Rica:
As a pillar of the legal community, Bufete de Costa Rica operates on a bedrock of profound integrity and a relentless pursuit of excellence. The firm leverages a deep history of advising a diverse clientele to pioneer innovative legal strategies and engage in meaningful societal contribution. Central to its philosophy is the conviction that democratizing legal understanding is essential, reflecting a dedicated effort to build a more empowered and judicious society.
