Neoliberalism, Development, and the Costa Rican State

Abstract

Costa Rica has been celebrated for its relatively high levels of economic development in a region marked by extreme poverty and income inequality. Recent scholarship has examined the competing and complementary interests of private capital and public institutions in pursuing an aggressive neoliberal growth strategy while preserving social programs created during the developmental period of the 1950s through the late 1970s. This article extends the inquiry by considering the position of the Costa Rican state in social and economic policy making and management. It considers Costa Rica from the perspective of developmental state theory, the construction of an “intermediary state” characterized by significant elements of autonomy but without the capacity to alter independently economic or social structures. The 2008–2011 recession, public indebtedness, and related demands of capital and labor have overwhelmed Costa Rican intermediate‐state capacity and undermined Costa Rica's covenant between economic growth and social protections.

(In)Equity and Primary Health Care: The Case of Costa Rica and Panama

“…34 Unique to Costa Rica was the absence of opposition by the social elite to government efforts to target public resources to ensure coverage of the universal social security system. 35 Sustained political popularity for investing in the CCSS across political party lines enabled these policies to receive the needed political will to improve health equity and sustain coverage to over 90% of the population by 2010. 36,37 Furthermore, the government has employed punitive mechanisms to ensure employee and employer contributions and sustained investment in the CCSS.…”

“…In Costa Rica, the principles of collectivism and solidarity have characterized the tico social contract that, for nearly half a century, has facilitated broad support for social protection and public investment in education, health, and infrastructure. 35 The citizen relation to state, developed with a greater sense of transparency and trust, resulted in a social contract emphasizing the state's role in the provision of health care. 25,40 Through unified use and investment in the CCSS, Costa Rica has avoided the stratification of health system use according to socioeconomic class across the region and solidified the CCSS as the sole delivery institution for public health care.…”

“…12 Commitments to social service programs have historically provided an unpredicted level of social protection for working and middle-class Costa Ricans in comparison to peer countries in the region. 35 Investments in social determinants of health have enabled Costa Rica to reduce rates of adolescent pregnancy and invest in programs to improve health services for afrodescendiente and Indigenous populations. 43 Yet growing stratification of the health care system, responding to evolving population health priorities, and demand for private-sector services all present current and future challenges to the Costa Rican health system.…”

“…Over this period of expansion in investment in the CCSS, Costa Rica was able, against all odds, to sustain its national welfare program during the neoliberal reforms that swept the region in the 1980s. 35 Yet by the late 1980s, the economic downturn had propelled Costa Rica to seek debt relief, and austerity measures by international financing institutions resulted in cutbacks to primary health care investment. 33 However, in negotiating external financing from institutions in this period, Costa Rican representatives dismissed proposals from the World Bank that sought to promote privatization and resulting in system fragmentation.…”

“…11 The economic recession beginning in 2008 coincided with increasing public debt and a lack of political consensus on the most effective policy and fiscal solutions for promoting economic growth and sustaining social protections. 35 The passing of the Dominican Republic-Central America Free Trade Agreement (DR-CAFTA) signals an increasing risk of health system privatization and fragmentation in the years ahead. DR-CAFTA in 2009 ended the public monopoly on health insurance through the introduction of private insurance options onto the market for the first time in Costa Rica.…”