Transforming health care in Costa Rica

Ashoka-Lemelson Fellow Rebeca Villalobos and her organization ASEMBIS (Asociación de Servicios Médicos para el Bien Social; or Association of Medical Services for the Common Good) have refined a financially sustainable model to offer high-quality medical care at affordable prices.  95% of ASEMBIS total budget is covered by patient fees; patients are drawn by promotional and discount programs, the possibility of financing through credit, and the affordable rates, even at full price.  26% of patients are considered low-income, many of whom receive 100% subsidies.  The other 5% of the budget comes from monetary or in-kind donations (technical training, medicine, equipment, etc.) from partner organizations, including Christoffel Blindenmission International, World Vision, and ASESA among others.  ASEMBIS constantly reassesses costs and prices through semi-annual market studies including considerations of inflation, minimum wages, market prices, inputs, and analysis of the competition. By segmenting the market, ASEMBIS has been financially self-sustainable for the past ten years.  They have served over 1,000,000 clients – 330,000 in the past year alone – and elements of her model have been adopted by organizations in Mexico, El Salvador, Honduras, and Panama.

In poor communities in Costa Rica and across Latin America, most citizens – adults and children alike – have never had their vision tested.  The eyesight examination chart, a standard feature of examination rooms in developed countries, is a novelty in these communities.  Adults with deteriorating eyesight and more severe ocular problems, like cataracts, are commonly left to stumble along toward preventable blindness, often jeopardizing employment opportunities and an already precarious livelihood.  Meanwhile children with even slight vision problems are often misdiagnosed by their teachers as learning disabled and placed unnecessarily in special needs classrooms.The situation is similar, if not worse, elsewhere in Latin America, and extends beyond ocular care to hearing and dental concerns as well.  Middle-income patients face a shortage of affordable, trained professionals ill-equipped to meet the demand, while low-income families are essentially excluded from these services altogether. 

ASEMBIS offers specialized, affordable, and high quality medical services including optometric consultations, ophthalmology, general medicine, audiology, otorhinolaryngology (ears, nose, and throat), clinical laboratory, ocular and auditory surgery, glasses, contact lenses, and hearing aids.  Patients paying full price receive first-class attention with cutting edge technology at 70% the price they would pay in the private sector. The six fully-equipped medical clinics are structured to reach different geographical regions of the country, including traditionally underserved rural communities.  Each clinic averages 300 patients per day and ASEMBIS counts on 163 professional staff hired according to their academic performance, professional skill, and positive attitude.  Every month over 4000 people buy glasses, hearing aids, and other accessories from ASEMBIS.

How could other countries, or industries, adopt the ASEMBIS model?