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.