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Health Aff (Millwood). 2017 Mar 1;36(3):531-538. doi: 10.1377/hlthaff.2016.1319.

Primary Health Care That Works: The Costa Rican Experience.

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Madeline Pesec ( is a medical student at the Warren Alpert Medical School at Brown University, in Providence, Rhode Island, and a primary health care intern at Ariadne Labs, a joint center of Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
Hannah L. Ratcliffe is a primary health care research specialist at Ariadne Labs.
Ami Karlage is a research assistant at Ariadne Labs.
Lisa R. Hirschhorn is a professor of medical social sciences at the Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and an affiliate member at Ariadne Labs.
Atul Gawande is executive director of Ariadne Labs, a general and endocrine surgeon at Brigham and Women's Hospital, a professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, and the Samuel O. Thier Professor of Surgery at Harvard Medical School.
Asaf Bitton is director of primary health care at Ariadne Labs, an assistant professor of medicine in the Division of General Medicine at Brigham and Women's Hospital, and an assistant professor of health care policy at Harvard Medical School.


Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.


Costa Rica; Empanelment; Multidisciplinary Teams; Population Health Management; Primary Care

[Indexed for MEDLINE]

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