A Small Country for Big Pharma Costa Rica推荐.pdfVIP

Chapter 8 A Small Country for Big Pharma: Costa Rica Antonio Ugalde and Nuria Homedes 8.1 Introduction 2 Costa Rica is a small country (approximately 51,000 km ; 19,730 sq. miles), with a per capita income of US$6,500 (2009), and a population estimate of 4.5 million people (2009). Half of the population resides in the capital, San Jose. The Costa Rican infrastructure is well developed, and literacy is almost universal. The Costa Rican Social Security Fund (CCSS) covers about 90 % of the population with comprehensive services that are offered at all levels of complexity, and include catastrophic diseases and pharmaceuticals. All services are free at point of service. It is important to know the history of the CCSS to understand the development of clinical trials in Costa Rica, the evolution of their regulations, and the conflicts that have arisen as a consequence of the trials. Until the mid-1970s, the Costa Rican health system was very similar to those of other Latin American countries. Medical services were provided by the CCSS and the Ministry of Health (MH), and the latter was also responsible for the provision of public health programs. Businesses had to enroll their employees in the CCSS, and the premiums were paid by the employer, the employee, and State contributions. Non-employed people received health care through the MH. This changed in 1974 when all MH infrastructures were transferred to the CCSS, which became respon- sible for providing health services to the entire population, while the MH remained responsible for public health and the stewardship of the health sector. At the beginning of the 1980s the CCSS provided all medical services to approximately 85 % of the population. Costa Ricans were proud of having a universal and affordable medical care system and free medicatio