My amazing wife -- mother of 2 and stepmom to my 2, full time employee and full time adult student -- recently wrote a brief paper about the Cuban healthcare system that compared it against key metrics with the system we have here in the United States. I admit I was near speechless with what she found. It is easy to be ashamed of America's general dysfunction on many fronts, basic care of its people perhaps the most glaring. But what really struck me was the thoughfulness and sincerity that seems to characterize the Cuban system.
Maybe you knew, but I certainly did not, that just maybe the model for a caring, efficient and effective healthcare system may be found less than 90 miles south of Florida. Read my wife's short paper below the squigs. ...And oh, the paper earned an A.
EFFICACY OF CUBA’S HEALTHCARE SYSTEM
The health care systems of Cuba and the United States were compared, evaluating the cost and efficacy of each system. Cuba maintains a socialist healthcare system has managed to keep healthcare costs among the lowest in the world per capita despite overwhelming adversity (Offredy, 2008). Statistics for overall health are almost equal to the most developed countries like Switzerland and the United States where the costs per capita are the highest. The Cuban system has mastered preventative and proactive family, community and acute care making it one of the most efficient and cost-effective in the world. Although Cubans do not get to choose their doctors, every citizen has an assigned doctor who provides healthcare, unlike the 47 million individuals in the United States who were unwillingly without health coverage in 2007 (Niles, 2011).
Since the 1960s Cuba has faced many adversities with the United States and her allies, such as trade embargos. Combined with the fall of its former patron, the Soviet Union, Cuba was forced to operate its universal goals of healthcare autonomously and with few resources. Prevention through community action and efficiency has become the only affordable way to keep its population healthy (Johnson 2011).
Compare Cuba’s annual per capita spending to the United States in 2005: healthcare spent per capita in Cuba was $260 per capita, while the spending in the United States was 25 times higher at $6,543 (Offredy 2008). This type of discrepancy should yield 25 times better care for the citizens of the United States, but it does not. Standard ways to measure the overall health of a countryinclude infant mortality and life expectancy rates. Cuba is nearly equal to the United Sates in both categories. In 2005, Infant mortality per 1,000 live births is seven in Cuba and 5.3 in the United States and overall life expectancy is 77.6 years in Cuba versus 77.7 in the U.S. (Offredy 2008).
Additionally, Cubans are paying zero dollars out of pocket with extremely high approval ratings of their healthcare (Offredy 2008), at the same time Americans are struggling to keep up with rising insurance premiums and those who cannot afford to pay for insurance are at risk of financial disaster in case of an accident or major illness in the family. Finally, Cuba’s doctor to patient ratio was 1:158 in 2005 (Offredy 2008) while the ration in the United States was a staggering 1:600 in 2004 (Nair 2004).
The three tier efficiency system of family doctors, specialty clinics and hospitals, which are all interconnected, eliminate inefficiency. First, Cuba educates its brightest and most ethically sound high school students, for free, to be doctors. As a result, in every neighborhood there is a doctor who often knows entire families for many years. The commitment of doctors is apparent since they commonly make house calls if someone misses an appointment, as phones are not commonplace. Every individual gets a check-up twice a year regardless of her health status. The personal relationships Cuban doctors build with patients often lead to early detection of disease, and more importantly, prevention of disease. If the Cuban doctor notices an elderly person becoming depressed he will encourage healthy social behavior like getting involved in community programs that are widely held (Offredy, 2008).
The second tier includes the specialty clinics, or polyclinics, which offer multiple and more formal medical services like rehabilitation, laboratory services, endoscopy and social work. The polyclinics reduce the incidence of hospital visits and therefore drive costs down. Family doctors ensure the patient has transportation and often accompany the patient to the clinic to personally participate in coordination of care. The entire clinic staff takes on the responsibility of health and prevention education (Offredy, 2008).
Last resort tertiary, or acute care, at hospitals are open and available with excellent care, but are used only if really needed. Since the patients had care prior to being admitted, a doctor already knows the condition of the patient and is able to validate whether hospitalization or acute care is necessary (Offredy 2008). In the U.S. people end up using hospital emergency rooms as their primary care because they cannot be refused care if it is an “emergency” (Niles, 2011).
Cuba’s Che Guevara (also a physician) had a vision to provide excellent preventative healthcare to every citizen in 1960. Finally in 1984, Cuba initiated the Family Doctor Programme where the goals are mainly preventative medicine, teaching and research (Offredy 2008). Despite major obstacles like a lack of supplies and a weak economy, Cuba forged ahead with its plan. Placing readily accessible doctors in every community increases the efficiency of care and it works. It is currently considered one to the healthiest countries in the world (Johnson 2011).
Pajoly note: One last thought I want to leave you with. However we manage to evolve our hideous system, one thing that must end: A dying child must not be a profit opportunity.
Fawthrop, T. (2003). Health for export. New Statesman, 132(4665), 32. Retrieved from EBSCOhost.
Hood, R. J. (2000). Cuban system offers an uncommon opportunity. Journal of the National Medical Association. Retrieved from http://www.ncbi.nlm.nih.gov/...
Johnson, T. (2011). APHA members travel to Cuba for insight on health strategies. Nation's Health, 41(2), 6. Retrieved from EBSCOhost.
Nair, S. (2004). Doctor shortage facing the U.S.. College Media Network. Retrieved from http://media.www.jhunewsletter.com/...
Offredy, M. (2008). The health of a nation: perspectives from Cuba's national health system. Quality in Primary