A Model of Health Care in Cuba

A Model of Health Care in Cuba: What can we learn from it?
M. Akhtar, Ph.D

The New England Journal of Medicine published Drs. Campion and Morrisey’s report on their recent visit to Cuba in January 2013. The article makes several startling observations, which addresses many of the concerns American have expressed with regard to their medical care. The debate around healthcare spanned decades and has reached its most recent zenith under the Obama administration. The latest political solution has been focused on universal healthcare coverage, which has raised questions on the adequacy of health care as well as the associated cost. In this back drop, a review of the Cuban system was thought to be relevant because it does provide universal coverage to its citizens going beyond minimum coverage to offer many additional benefits. Of course the Cuban healthcare system operates in its own societal context, which is sharply different from ours. Quote the authors, “Although Cuba has limited economic resources, its health care system has solved some problems that ours has not yet managed to address.” To elucidate on this, a few specific selections of the Cuban system are outlined below:
Cuba is far from being developed in having economic resources, infrastructure, technology , and smart phones;internet access is virtually nonexistent. The medical system is run not by computer-based communications, but via simple handwritten records as they used to be in America half a century ago..Yet,the Cuban health care system seems unreal. Despite the lack of sparkling hospitals with shining floors, adjustable beds in semiprivate rooms, and lack of world renowned specialists who devised new procedures or perfected techniques, the Cuban system is successful in providing health care to the entire country and is not too bad in giving high quality care either. Life expectancy of Cubans is 78, that is equal to Americans. Their highly structured, prevention-oriented system has produced positive results. Vaccination rates in Cuba are among the highest in the world. The life expectancy of 78 years from birth is virtually identical to that in the United States. The infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 — lower than the U.S.rate, although the maternal mortality rate remains well above those in developed countries and is in the middle of the range for the Caribbean countries… What do we attribute the improved health outcomes to? It is a fact that the system is tightly organized and has a key emphasis on prevention
Without doubt, the improved health outcomes are largely the result of improvements in nutrition and prevention. f Financial resources and total expenditures for health care in Cuba are by far too low to provide any explanation for improved health system. Cuba’s literacy rate is 99%, and health education is part of the mandatory school curriculum. A recent national program to promotes acceptance of men who have sex with men was designed in part to reduce rates of sexually transmitted disease and improve acceptance of and adherence to treatment. Cigarettes can no longer be obtained with monthly ration cards, and smoking rates have decreased, though local health teams say it remains difficult to get smokers to quit. Contraception is free and strongly encouraged. Abortion is legal but is seen as a failure of prevention.
Cuba has too many doctors who got education free. Medicare is free. .Everything is free, totally free — and not after prior approval or some co-pay. It is tightly organized, and the first priority is prevention.
Everyone is assigned a family physician who along with other health care workers delivers primary care and preventive services at the local level. Caregivers generally live in the same community. Family physicians along with other workers are responsible for delivering care to their patients- about 1000 patients per physician in urban areas. Every patient is visited at home once a year, and those with chronic conditions receive visits more frequently. When necessary, patients can be referred to a district polyclinic for specialty evaluation, but they return to the community team for ongoing treatment. House calls and discussions with family members are common tactics for addressing problems with compliance or follow-up and even for failure to protect against unwanted pregnancy. In an effort to control mosquito-borne infections such as dengue, the local health team goes into homes to conduct inspections and teach people about getting rid of standing water, for example
Cuba’s expenditure per capita for health care is only a fraction of what is spent in America, yet it has universal coverage and every person receives health care. More importantly, the advances in health quality are credited to the social and educational system of Cuba. Regarding the explanation of the low expenditures on healthcare, it is largely due to the absence of litigation against physicians or other medical malpractice law suits. Physicians have no need for malpractice insurance, meaning a dramatic reduction to the exorbitant cost of medical care.. Many doctors would defend the high cost of medical care as a consequence of doctor’s time, long years of expensive schooling and study, and careful administration of care and medicine. The Cuban system dispenses with these justifications in their unique structure.
In Cuba, P physicians are paid only about $20 per month with food and housing at high subsidies given by the government. Their education is free that keeps living in general affordable. Cuba is a country where 80% of the citizens work for the government, and the government manages the budgets. Physicians are respected, but they are unlikely to attain personal wealth.
Cuba has too many doctors as their education is free. Cuba now has more than twice as many physicians per capita as the United States. Many of those physicians work outside the country, volunteering for two or more years of service, for which they receive special compensation. In 2008, there were 37,000 Cuban health care providers working in 70 countries around the world as part of Cuban foreign aid.
All in all, Cuba’s achievements in health care are admirable. Many of them, however, are obviously the function of a socialist governance structure, mostly unpalatable to the American taste, which characteristically tends toward individualism. Despite social drawbacks to this individualistic orientation in the American system, it is known to produce unparalleled efficiency and innovation. American healthcare is poised to treat conditions and diseases ranging from life-threatening to cosmetic, but unfortunately the number of Americans who can afford any of these treatments without the benefit of considerable insurance coverage are only modest in number. As the Obama administration continues its rollout of the universal healthcare platform, the pressure to spare taxpayers undue cost may well move the nation towards the seemingly socialist model of healthcare, that is gaining credibility and is becoming familiar in the developed world. One need only to look to Canada and across the European Union. As the US works to refine this model on an immense scale, the Cuban model can be of great use to American.

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