The World Bank in 2004 sought to explain socialist Cuba’s success in public health, and juxtaposed Costa Rica as a contender for similar public health gains, through the orthodox model which stresses broad based growth , backed by increased private investment. However a unique public institution (the Caja Costarricense de Seguro Social) for health and social security insurance better explains Costa Rica’s health advances, and its superior performance to some higher income Latin American countries such as Mexico and Argentina. The relationship between increased income and improved health is positive, but weak and fragile. Other factors which may be more important are: levels of education (especially of women), numbers of trained health workers, universal access regimes for health services, well coordinated public health institutions, decent housing, and the adoption of new technologies. The experience of Latin America tells us that greater attention must be paid to well-organized public institutions, including those which train health workers, arrange universal access to health services and ensure adequate water, sanitation and housing.

2007 Health, income and public institutions: Explaining Cuba and Costa Rica PDF

New School Economic Review, 2(1)