Americans have known about Costa Rica for years. US retirees have been heading to the country to get their teeth done since the 1980s. Although Costa Rica offers a wide range of medical treatment services; from physical checkups, to plastic surgery, orthopedic, spine, bariatric, IVF, stem cells and anti-ageing therapies, almost half of the medical travellers visit Costa Rica for dental procedures.
Although Costa Rica has heavily marketed itself as a dental service hub, it also relies heavily on word-of-mouth for international clients says Alberto Meza, who runs Meza Dental Care, one of many small clinics across the country able to carry a procedure at the fraction of the cost of the US. Although Meza says 95 per cent of its clients are American, he does receive visitors from countries like Italy, Germany, Japan, Australia, Canada. “We do not get patients from neighbouring countries,” he added.

High-quality professionals
But compared to many of the giants of medical travel, Costa Rica is a tiny country with a tiny medical travel industry. The Council for International Promotion of Costa Rica Medicine (PROMED), has estimated that 70,000 medical travellers visited in 2016 and brought in US$485 million. The industry has been growing 15 per cent per year since 2006. There are a few hundred private hospital beds in the country.
People visit Costa Rica because it has good medical professionals and facilities said Alvaro Piedra Meléndez, of Procomer, despite not being the cheapest destination in the region, Costa Rica’s export agency. “It should be noted that the main success factors for Costa Rica as an actor in this industry is the high quality of their professionals,” he said. Importantly, Costa Rica, which has the oldest democracy in Latin America, also has political stability and high standard of living. That’s what sets it apart from its Central American neighbours according to the US’s Central intelligence agency.
Unsurprising then, that US citizens are still the largest proportion of Costa Rica’s medical travellers, by far. About 83 per cent came from the US and 11 per cent from Canada in 2016. Costa Rica also receives patients from Central America and the Caribbean, who have tried the public health system at home but seek complex procedures not available in their countries; cancer treatments, liver transplants and radiotherapy for example.

Compared to many of the giants of medical travel, Costa Rica is a tiny country with a tiny medical travel industry

Interestingly, there is very little contact with insurance companies, a feature of much of the industry in Costa Rica. “We are not making moves to work with insurance companies, just fill in forms for patients to make their claims,” said Meza. “All of our clients pay out of pocket.”

Great growth
PROMED - and the government - are trying to change that, however said Massimo Manzi, Head of PROMED. “Around 85 per cent of patients pay out of pocket, but Costa Rica is trying to develop corporate and institutional programmes where procedures are sponsored either by self-funded employers, an insurance company or a foreign Government,” he said.
Those companies prepared to pay for patients to seek health in Costa Rica have very specific programmes. “US corporations have focused their programmes in Costa Rica in orthopeadics, neurosurgery and weight loss surgery,” he said.
Public hospitals are not permitted to receive private international patients either. So, medical travellers tend to visit one of three JCI-accredited hospitals in the country. Two of the JCI-accredited hospitals are Hospital Clínica Bíblica (HCB) and CIMA Hospital, owned by the International Hospital Corporation, which is headquartered in Dallas, Texas. Hospital Metropolitano, is based in San José downtown and is the newest hospital, opening eight years ago. It provides services to US veterans and accepts medical insurance under the Foreign Medical Program (FMP) and Tricare.  The next largest private hospital, Hospital Hotel La Católica (HCC), is accredited by the Costa Rican Medical Tourism Associations.

Public hospitals are not permitted to receive private international patients

Much growth is envisaged. Both CIMA Hospital and Hospital Clínica Bíblica are building new facilities in the Guanacaste Province, the area in northwest Costa Rica which attracts the greatest portion of tourists and has an international airport with direct flights from the US CIMA Hospital’s new site in Liberia and HCB’s facility is in the Papagayo area, but it plans an outpatient clinic in Santa Ana in the near future.
Juan Andrés Castro, Gerente Comercial at JCI-accredited Hospital Metropolitano in San José said his hospital targets mostly domestic patients, although many of those may be foreigners living in Costa Rica. “Our mission is to provide the best medicine care at the best price. It focuses very much on local,” he said. “We also have a large number of expats and veterans that live in our country that we serve regularly,” he said.
Hospital Metropolitano too has eyed growth opportunities and has opened two primary care branches in the main tourist areas of Quepos and Guanacaste. Those clinics report about a 50-50 share among local and foreigners. “In time, we have seen an increase of request for more treatments in our main site in San Jose. We plan another two next fiscal year. One of which will have an OR and hospitalisation services. At the moment that’s only available in San Jose,” he said.

Among the best
As well as these hospitals, there is a wide range of smaller private clinics – the largest of which are Clinica Santa Catalina, Clínica Santa Rita, Clínica Santa Fe, and Hospital Clínica Jerusalem. Private patients can be seen quickly in these facilities, which are accredited by the Association for Ambulatory Healthcare (AAAHC). 
Although the main hospitals are concentrated around the Central Valley, where the capital is, PROMED said it has been working with the German Cooperation Agency to create regional local medical and wellness travel clusters in other areas such as Guanacaste, Jacó, Los Santos and La Fortuna.
Recovery centres, too, allow patients to recuperate at a special ranch or accommodation centres with medical staff. They include CheTica Medical Recovery Centre and Paradise Cosmetic Inn in the mountains near the capital.
But, some within the industry say government could do more. “Local government does not promote the industry, it seems they do not believe in it as a profit-maker for the country,” says Meza of Meza Dental. “There is lots to do – regulating the industry and then promoting it to make it sustainable”.
The fact is, Costa Rica has one of the best health systems in the region and investments in health infrastructure has impacted on service levels and health professionals. “The country is well prepared and now suffers of an oversupply of medical and dental professionals,” said Manzi. “So far, the private sector has been doing most of the effort but with the involvement of the Government we believe we can open new markets more easily.”
He wants the government to negotiate with the Ministries of Health of third countries to offer medical services and also medical professionals, for example. “We believe this is an opportunity to accelerate the growth of the industry with a stronger support from the Government.”
The Ministry of Foreign Trade, Ministry of Foreign Affairs, Ministry of Health are also thought to be on the verge of passing an executive decree to help boost the medical travel industry. Meléndez said that the government is active. “Procomer is reinforcing market studies, missions and fairs, and during 2017 the sector is participating in medical travel summits and a commercial mission in Guatemala and Honduras,” he said.