The social security health system and the use of its services among nicaraguans in Costa Rica

Abstract

The argument that immigrants tend to make greater use of health services, displacing the local population, is well-known. The goal of this study is to compare affiliation to the Costa Rican national health care system and the use of health services among Nicaraguans in Costa Rica and the Costa Rican population for the year 2004 and their evolution in recent years (1998–2004). The results of this study are based on the National Survey of Income and Expenses (Encuesta Nacional de Ingresos y Gastos ENIG-2004). The gross number of those with insurance is 17 percent lower in Nicaraguan households. The ratio of net consultations (without taking into consideration noncontributing members) in Nicaraguan households is 17 percent greater than that of Costa Ricans. These differences remain the same when the place of residence is taken into consideration. Since 1998, the total number of those insured has risen five percentage points in Nicaraguan households and decreased five points for Costa Ricans. After making adjustments to take into account the effect of those not insured, a greater decrease can be perceived in the number of those insured in Costa Rican households since 1998. Since then, the ratio of net consultations has increased 43 percent in Nicaraguan households, in contrast to the 25 percent increase in Costa Rican households. These results suggest a possible lack of credibility in public institutions on the part of the Costa Rican population, while, in a parallel manner, it seems that the migrant population is investing more in public services, as it should be in contributive regimes. Beyond that, the study calls into question the arguments against migration and the xenophobic discourse against social minorities in Costa Rica which are nourished by the supposed burden placed on the public health system by Nicaraguan migrants.