Doctor’s Tip: Health care in Cuba — maybe we can learn something
Understandably, a growing number of Americans are dissatisfied with our expensive, dysfunctional health care system. We spend far more money on health care than any other country, yet rank far down the list of most measures of health outcomes. Complications of our health care system (errors, missed diagnoses, hospital-acquired infections, etc.) are the third cause of death, following heart disease and cancer.
As politicians look for solutions, it’s important to look at successful health care systems in other countries. Today’s column is about health care in Cuba, based in part by an article that appeared in The Atlantic Monthly magazine in 2016, that a medical school classmate sent me recently. The title is “How Cubans Live as Long as Americans at a Tenth of the Cost.”
Cuba certainly has its problems. But it is known for its medical education — which is free, like all education there. Free health care for all citizens is a constitutional right. In order to make this system work in a poor country like Cuba, the emphasis is on prevention — keeping people healthy, as opposed to the expensive “disease management system” that we have in the U.S.
The Cuban system is based on primary care, and Cuba has twice as many primary care doctors per capita as the U.S. does. Family doctors and nurses work in teams, and are assigned to live in a particular neighborhood, and care for everyone in that neighborhood. At least once a year the doctor sees each patient for whom they are responsible, in the patient’s home. Doctors are trained to talk about healthy lifestyle, such as nutrition, exercise and tobacco cessation. These check-ups also involve questions about jobs, social lives and living environment (which is easy to assess given the home visit). Doctors then put patients into risk categories, which determine how often patients need to be seen in the future. If necessary, primary care doctors refer patients for specialty care.
In 2016 Cuba spent $813 per person annually on health care — in American we spent $9,403. In spite of Cuba being a poor country, their longevity is the same as ours, and their infant mortality is lower. They have one of the lowest rates of vaccine-preventable diseases in the world (vaccinations are mandatory). Years ago, the World Health Organization ranked countries according to the fairest mechanism of health-system finance and put Cuba first in Latin America and far ahead of the U.S.
Of course, the Cuban system isn’t perfect. For example, people don’t have a choice of providers, and pay for doctors is low. Due to lack of money and the U.S. embargo, medical supplies and pharmaceuticals are sometimes hard to come by. Hospitals are often old and in disrepair. But maybe we in the U.S. can learn something from the good parts of the Cuban system.
The Atlantic article concludes by saying this: “While Cuba’s situation is far from ideal, it serves as an elegant counterpoint to the three-trillion-dollar U.S. health-care system — which is controlled by corporations [privatized insurance, pharmaceutical, medical-device, and hospital systems] that drive people to pay exorbitant costs [either directly or through taxes]. Cuba offers a dire reminder that efficient healthcare can be provided at much less cost to the people — when the focus is on primary care and prevention.”
Retired physician Greg Feinsinger, M.D., is author of new book “Enjoy Optimal Health, 98 Health Tips From a Family Doctor,” available on Amazon and in local bookstores. Profits go towards an endowment to the University of Colorado School of Medicine to add prevention and nutrition to the curriculum. He is available for free consultations about heart attack prevention, diabetes reversal, nutrition, and other health issues. Call 379-5718 for an appointment. For questions about his column, email email@example.com.
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