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Recent National Academies of Sciences reports have summarized evidence to understand why US health indicators lag those of other countries, in an effort to explore the fundamental question of why some populations live longer than others.However, this literature has failed to engage in the potentially more striking comparisons with countries that outperform the United States despite wielding many fewer resources.It also addresses the relative explanatory importance of health care systems and behavioral factors in the two countries.

1, which was built with World Bank data for the 5-y period before the Great Recession and with per capita gross domestic product purchasing power (GDP-PPP) as the indicator of economic well-being.

Mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the United States.

This comparison simultaneously shows the potential for substantially lowering mortality in other middle-income countries and highlights the United States’ poor health performance.

Costa Rica, a small Central American country comparable to the states of South Carolina or Kentucky in territory and population size, is also known for being the oldest democracy in Latin America, with a government that invests substantially in social redistributive programs.

These investments have in part been enabled by eliminating the financial burden of military expenditures after abolishing its armed forces in its 1949 Constitution (10–12).

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According to the 2011 census, 86% of Costa Ricans (96% of older adults) are covered by the public health insurance and care system known as the CCSS.

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