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I don't live in Costa Rica, but I have family there and they have combined. They complain that the private healthcare systems lobby to underfund the public heathcare system in order to turn people away from public healthcare, and off to their services where they make more money.
So combined systems cannot exist, if you want public healthcare then it should quickly phase our private.
My personal horror story is that I took the time to make sure I went to an in-network hospital before I went to the ER for what ended up being an emergency appendectomy. The surgeon was in-network...for scheduled appendectomies. Emergencies were contracted out to a different organization who he was working for at the time, and that organization was not in network. So I got balance billed for it. I took the payment my insurance company gave me and sent it to him and said "look, I did all this research ahead of time and at no point did anyone ever tell me this would be out of network, so this is all you're getting out of me." They left it at that.
In most developed countries, health care is rationed by need. In the US we ration by ability to pay. I would gladly pay more for worse service so long as care was rationed by need.
