[Unpaid long-term care in Costa Rica: state savings and social debt]

To quantify the state savings derived from unpaid long-term care work provided by informal caregivers in Costa Rica and to estimate the public investment that would be required if the population received the legally mandated services according to their level of dependency.

A mixed-methods approach was applied to estimate current savings and investment. First, the economic valuation of formal long-term care services -long-stay residential facilities, day centers, and teleassistance- was calculated using a top-down cost approach. Second, home-based care was assessed using the replacement cost method. Administrative microdata and the 2023 National Disability Survey and 2024 Household Survey were analyzed. The analysis was complemented by a review of institutional records and interviews with public and private long-term care service providers.

The monetary valuation of state savings derived from informal care for people with moderate and severe dependency represents approximately 0.49% and 0.76% of gross domestic product, respectively. In contrast, current public investment is estimated at 0.08%, leaving 94% of the dependent population without public support. This gap, assumed by families -mainly women- reflects a structural state saving sustained by informal caregivers.

The State is indebted to families. Long-term care systems rely on unpaid caregiving labor that sustains, without recognition or compensation, a structural public gap in social and health protection. Sustainable financial resources, accessible public services, and effective support measures for caregivers are urgently needed.