---
type: source
title: "Costa Rica's EBAIS Primary Health Care System: Near-US Life Expectancy at 1/10 Spending"
author: "Multiple sources (IMF, Commonwealth Fund, Exemplars in Global Health, PHCPI)"
url: https://www.exemplars.health/stories/costa-ricas-health-success-due-to-phc
date: 2022-03-09
domain: health
secondary_domains: []
format: report
status: null-result
priority: high
tags: [costa-rica, ebais, primary-health-care, international-comparison, spending-efficiency, blue-zone]
processed_by: vida
processed_date: 2026-03-11
enrichments_applied: ["medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm.md", "pace-demonstrates-integrated-care-averts-institutionalization-through-community-based-delivery-not-cost-reduction.md", "the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
extraction_notes: "Two new claims extracted: (1) Costa Rica as proof that prevention-first primary care at national scale achieves peer outcomes at fraction of US cost, (2) geographic empanelment as the structural mechanism enabling population health management. Three enrichments: extends the 10-20% medical care claim with strongest international counterfactual, extends PACE claim with national-scale comparison, confirms healthcare attractor state but challenges whether technology is prerequisite vs accelerant. Key insight: EBAIS-PACE comparison reveals same clinical model, wildly different scale — difference is political economy not care design."
---

## Content

### EBAIS Model

- Equipo Basico de Atencion Integral de Salud (Basic Comprehensive Health Care Team)
- Introduced 1994: multidisciplinary teams assigned to geographically empaneled populations
- Each team: doctor, nurse, technical assistant, medical clerk, pharmacist
- Provides care both in clinic AND directly in the community
- Universal coverage under social insurance system (CCSS)

### Health Outcomes

- Life expectancy: 81.5 years (female), 76.7 years (male)
- Ranks **second in the Americas** behind Canada
- **Surpassed US average life expectancy** while spending less than world average on healthcare
- Districts with EBAIS: 8% lower child mortality, 2% lower adult mortality, 14% decline in communicable disease deaths

### Spending Efficiency

- Spends **1/10 per capita** compared to the US
- Below world average healthcare spending as % of income
- Focus on preventive care and community-based primary health care
- "Pura vida" philosophy: health embedded in cultural values (healthy = having work, friends, family)

### Structural Mechanism

- Universal coverage + community-based primary care teams + geographic empanelment
- Prevention-first by design (not by payment reform — by care delivery design)
- Costa Rica's success is due to **primary health care investment**, not "crazy magical" cultural factors
- The EBAIS model is replicable — it's an organizational choice, not a geographic accident

### Blue Zone Connection

- Nicoya Peninsula is one of the world's 5 Blue Zones (highest longevity concentrations)
- But Costa Rica's health outcomes are national, not just Nicoya — EBAIS covers the country

## Agent Notes
**Why this matters:** Costa Rica is the strongest counterfactual to US healthcare. Near-peer life expectancy at 1/10 the cost proves that population health is achievable without US-level spending. The EBAIS model is structurally similar to what PACE attempts in the US — community-based, geographically empaneled, prevention-first — but at national scale. PACE serves 90K. EBAIS covers 5 million.
**What surprised me:** The replicability argument. Exemplars in Global Health explicitly argues Costa Rica's success is PHC investment, not culture. This challenges the "you can't compare" defense US healthcare exceptionalists use.
**KB connections:** [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]], [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]]
**Extraction hints:** Claims about: (1) Costa Rica as proof that prevention-first primary care at national scale achieves peer-nation outcomes at fraction of US cost, (2) EBAIS as organizational model (not cultural artifact) that demonstrates replicable primary care design, (3) geographic empanelment as the structural mechanism that enables population health management

## Curator Notes
PRIMARY CONNECTION: [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]]
WHY ARCHIVED: First international health system deep-dive in the KB. Costa Rica is the strongest counterfactual to US healthcare spending.
EXTRACTION HINT: The EBAIS-PACE comparison is where the real insight lives. Same model, same concept — wildly different scale. What's different? Political economy, not clinical design.


## Key Facts
- Costa Rica life expectancy: 81.5 years (female), 76.7 years (male) — second in Americas
- Costa Rica healthcare spending: 1/10 per capita vs US, below world average as % of income
- EBAIS introduced 1994, covers 5 million population
- EBAIS team composition: doctor, nurse, technical assistant, medical clerk, pharmacist
- EBAIS districts show 8% lower child mortality, 2% lower adult mortality, 14% decline in communicable disease deaths
- Nicoya Peninsula is one of 5 global Blue Zones, but Costa Rica's health outcomes are national not regional
