Costa Rica
A Latin American high performer on palliative care development indicators, with a national pain and palliative care centre inside a single public health system.
8 domains reviewed · 8 high-confidence · 2 dated estimates · 9 material gaps
WHO region: Americas. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 8 of 9
- Hospice: 0 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 6
- Newest source 2026Thin evidence
Lessons from Costa Rica
- The regional analysis links more than one postgraduate programme with higher service density. Education capacity is one of the strongest predictors a country can act on directly.142
- After a digital prescription system and tighter oversight, national opioid use fell by about seventy percent, morphine included. A monitoring system without access safeguards can cut medical use along with misuse; pain-relief access should be tracked, not only diversion.143
- A single public health system with a national centre produced the region's highest development score. Federal or provincial systems can anchor a comparable centre in each subnational unit.142
- One national pediatric palliative team linked to social security, a foundation and primary care clinics can reach children with life-limiting conditions across a small country, including by home visits.319
- When a digital controlled-substance prescription system coincides with steep falls in morphine and methadone dispensing, countries should check whether palliative patients lost access.143
Palliative care
Is morphine available in Costa Rica?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 70 percent, approximateSOURCE-CHECKED
Fall in national opioid consumption from the 2018 peak, Costa Rica, 2023143
Last checked 2026-09-24.
Morphine fell 72.2 percent over 2017 to 2024.
Cite this figure:
Costa Rica was classed a moderate consumer in regional surveys. National registry data show consumption peaking in 2018 and then falling sharply, with morphine among the largest declines.144,143
Did the fall reflect reduced misuse or reduced access for patients in pain? The registry study does not separate them.
Help answer it:Search PubMedHow does Costa Rica regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Stronger regulatory oversight, including a national digital prescription system for controlled substances, coincided with the post-2018 fall. Regional surveys describe over-regulation as a standing barrier.143,144
Which statute governs opioid stocking and dispensing, and what does the digital system require of prescribers?
Help answer it:Search PubMedWho can prescribe morphine in Costa Rica?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Who may prescribe oral morphine, and is there any non-physician role?
Help answer it:Search PubMedHow does palliative care reach patients in Costa Rica?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 8.10 index score, highest in the regionSOURCE-CHECKED · 2012 DATA
Latin American palliative care development index, Costa Rica, 2012142
Last checked 2026-09-24.
Cite this figure: - 14.65 per millionSOURCE-CHECKED · 2012 DATA
Palliative care services per million inhabitants, Costa Rica, 2012142
Last checked 2026-09-24.
Second of nineteen countries, behind Chile.
Cite this figure:
In the early 2010s Costa Rica led Latin America on the composite development index and ranked second on service density, anchored by a national pain and palliative care centre.142
How many teams operate today, and how are they spread across the social security regions?
Help answer it:Search PubMedWho pays for palliative care in Costa Rica?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Costa Rica's national pediatric palliative care program is supported by the Costa Rican Social Security System and by a non-governmental foundation, Fundacion Unidad Pro-Cuidados Paliativos, which hires staff, funds home visit supplies and gives aid to the poorest families. This describes the pediatric program only.319
How is adult palliative care in the 23 Ministry of Health accredited clinics financed, and what do patients pay out of pocket?
Help answer it:Search PubMedHow are palliative care clinicians trained in Costa Rica?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Costa Rica was among the few countries in the region with more than one postgraduate palliative programme for physicians, which the regional analysis associates with higher service density.142
How does Costa Rica prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Costa Rica tracks opioid dispensing through a Ministry of Health narcotics registry and a national Digital Prescription System for controlled substances. Total opioid consumption fell about 70% from its 2018 peak through 2023, with morphine down 72.2% and methadone down 82.4%, from a 2014 baseline already at or below 5 mg morphine equivalent per capita.143,232
Did the post-2018 decline in morphine and methadone dispensing reduce access for palliative care patients, and what opioid agonist treatment and naloxone access exists in Costa Rica?
Help answer it:Search PubMedHow do children get palliative care in Costa Rica?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
A single national pediatric palliative care program, founded in 1990 at the National Children's Hospital, serves about 1300 children, 60% with central nervous system conditions and 15% with cancer. It offers inpatient consults, home visits across the country and a day hospital, supported by the Costa Rica Social Security System and a foundation.319,743
How does Costa Rica ensure child-appropriate opioid formulations reach children at home in remote regions, and how are consent and disclosure handled with adolescents?
Help answer it:Search PubMedHospice care in Costa Rica
How the hospice model works here, who can use it, who pays and who it reaches. Covered 0 of 4.
What does hospice care look like in Costa Rica?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
PubMed returned no Costa Rican source that discusses hospice as a concept; sources describe palliative care clinics and a national pediatric palliative care program. Does Costa Rica have inpatient or home hospice services distinct from its palliative care clinics?
Help answer it:Search PubMedWho can get hospice care in Costa Rica?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
No hospice-specific eligibility rules for Costa Rica were found in PubMed. What criteria govern entry to end-of-life residential or home services?
Help answer it:Search PubMedWho pays for hospice care in Costa Rica?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
No PubMed source describes hospice funding in Costa Rica. Does the Costa Rican Social Security Fund (CCSS) pay for any hospice-type care, and what role do foundations play?
Help answer it:Search PubMedHow many people reach hospice in Costa Rica?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
No PubMed source reports hospice numbers or hospice use in Costa Rica. How many hospice-type beds or services exist, and who is left out?
Help answer it:Search PubMedSources cited here
- 144Cleary J, De Lima L, Eisenchlas J, Radbruch L, Torode J, Cherny NI.
Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI). Annals of Oncology 2013;24(Suppl 11):xi41-xi50. DOI 10.1093/annonc/mdt502. Abstract read. Costa Rica among the countries with moderate consumption by international standards, with over-regulation common across the region.
- 143Zavaleta-Monestel E, Arguedas-Chacon S, Mora-Jimenez J, Wu-Chin C, Rodriguez-Miranda R.
Nationwide trends in opioid consumption in Costa Rica, 2017-2024: implications for regulatory policy and public health. Pharmacoepidemiology and Drug Safety 2026;35(7):e70421. DOI 10.1002/pds.70421. Abstract read. Ministry of Health narcotics registry: national opioid consumption peaked in 2018 and fell by about seventy percent to 2023, with morphine and methadone falling most, alongside stronger regulatory oversight including a national digital prescription system for controlled substances.
- 142Pastrana T, Torres-Vigil I, De Lima L.
Palliative care development in Latin America: an analysis using macro indicators. Palliative Medicine 2014;28(10):1231-1238. DOI 10.1177/0269216314538893. Latin American atlas indicators for 2011 to 2012 across nineteen countries: Costa Rica had the highest composite development index and the second highest service density, and was among the few countries with more than one postgraduate palliative programme for physicians. Full text read.
- 319Gómez García WC, Rivas S, Paz G, et al.
Pediatric Oncology Palliative Care Programs in Central America: Pathways to Success. Children (Basel) 2021;8(11). Narrative review by program clinicians describing pediatric palliative care programs in six countries, including the national pediatric program in Costa Rica; written by program staff (self-report). Full text read.
- 232Maia LO, Daldegan-Bueno D, Fischer B.
Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Substance Abuse Treatment, Prevention, and Policy 2021;16(1):12. Low availability versus high-income countries, mid-level in Latin America; codeine dominant; morphine and codeine on the essential list; special form, prescription notification and supply limits; physician and dentist prescribing only; out-of-pocket prescription cost. Abstract and full text read.
- 743Irola Moya JC, Garro Morales M
Pediatric palliative care, Costa Rica's experience. Am J Hosp Palliat Care 2010;27(7):456-64. Descriptive review of 1445 children referred to the National Children's Hospital pediatric palliative care clinic from 2000 to 2008; pre-2012, single service, written by its own staff. Abstract read.