Perhaps the most impressive impact of Costa Rica's modern welfare state has been the truly dramatic improvements in national health. Infant mortality has plummeted from 25.6% in 1920 to only 1.5% in 1990. The annual death rate dropped from 41 per thousand in 1894 to 18 in 1944 and just 3.9 per thousand in 1989. And the average Costa Rican today can expect to live to be a ripe 73.2 years old-longer than the average U.S.-born citizen. All this thanks to the Social Security system which provides universal insurance benefits covering medical services, disability, maternity, old-age pensions, and death.
Currently Costa Rica assigns about 10% of its GNP to health care. The result? A physician for every 700 people and a hospital bed for every 275. In fact, in some areas the health-care system isn't far behind that of the U.S. in terms of the latest medical technology, at least in San Jose, where transplant surgery is now performed. Many Americans fly in for surgery, including dental work, here. And the Beverly Hills crowd helps keep Costa Rica's cosmetic surgeons busy.
One key to the nation's success was the creation of the Program for Rural Health in 1970 to ensure that basic health care would reach the furthest backwaters. The program, aimed at the 50% of the population living in small communities, established rural health posts attended by paramedics. The clinics are visited regularly by doctors and nurses, and strengthened by education programs stressing good nutrition, hygiene, and safe food preparation. Even a few years ago malnutrition reaped young Ticos like a scythe; in the last two decades infant mortality due to malnutrition has fallen by over 80%. In April 1992, the Social Security service initiated a new plan aimed at lowering infant mortality to one percent. It's a constant battle, however. Health standards slipped slightly in 1990-91 due to budget cutbacks: the tuberculosis rate doubled in 1991, for example, and that year the nation witnessed its first measles epidemic in many years. But then again, so did the United States.