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Cuba Vs. US Health Care

Friday, June 30, 2017


Since relationship with Cuba is a top news story, today's Friday Pearl features some of the differences between Cuba and the US health care system. We will also feature Cuban history and music for this coming Sunday's Stop at the Intersection of Science, Art, Music and Humanities.


The obvious place to start: The US government is suggested to spend 17.8 percent of its GDP on health care, which is supported by 2015 data from the US Centers for Medicare & Medicaid Services website. 


The World Bank 2014 data suggested that we spend more than $9,000 per person in our country on health care. These expenses have doubled since 1995, making the US, by far, the highest health care spender in the world.  


The World Bank health expenditure per capita 2014 data also reports that Cuba spent $817 per person on universal health care, a bit more than 11 percent of GDP.  


The 2015 AMA annual report states that there are more than 900,000 licensed physicians in the US. These doctors serve the health care needs of 321 million people, according to the 2014 National Center for Health Statistics


Cuba has 33,000 physicians to serve the healthcare needs of 11.39 million Cubans.


Outcomes


Life expectancy at birth in 2015 in Cuba was almost identical to that of the US: 77 for men and 81 for women, in spite of a 55-year US-imposed trade embargo and loss of its main trading partners with the collapse of the Soviet Bloc more than a decade ago.   

  

WHO also reported that specialization in family medicine is a requirement for more than 97 percent of Cuban medical graduates, who also spend one internship year and two residency years in training after they receive their medical degrees.  


The major difference: Cuba puts far more focus on disease cause and prevention than US health care does. While diagnosis and treatment focus is enormously profitable for manufacturers of high-tech diagnostics and big pharma, Cuba’s low-tech system data suggest that their health care system is, overall, considerably more effective than ours—per dollar spent. All Cuban doctors work for the government and make far less money than US doctors, but their education is totally paid for by the government.


Primary care in Cuba


According to the WHO, in Cuba, it's all about smart use of limited resources. Universal vaccinations were introduced in the 1960s; in the 1970s, there was a big push to improve maternal and prenatal care. They also provide free birth control, cancer screening and abortions, when necessary to protect the health of the mother, or when requested by the mother, with abortion being treated as failed prevention. 


There is also a major emphasis on primary health care, with the enviable centerpiece of this system being the community-based polyclinic, with the clinic acting as the organizational hub for 20 to 40 neighborhood-based family doctor-and-nurse offices, and as accredited research and teaching centers for medical, nursing and allied health sciences students. 


These clinics seem to serve as the backbone of the Cuban health care system. 


Infant mortality


The 2015 World Bank infant mortality data clearly suggests that infant mortality is lower in Cuba (4 out of every 1,000 live births) than in the US (6 out of 1,000 live births), and good prenatal care seems to now be the norm in Cuba.


An obvious question to ask: is the data collection method the same in both countries. I'm told that infant mortality data collection in the US starts at birth, but a few months after birth in Cuba. This might explain some of the reported differences, but I could not find literature to support that possible difference claim.


Addressing disease cause and prevention, and the role lifestyle plays in health always gets our attention, but one of the major differences is that the Cuban government teaches the health care receiver to be accountable for lifestyle choices that contribute to health maintenance. When they are not accountable for their own health, they are required to show up for counseling, or they will receive a visit in their homes by professional or allied health care workers to determine future access to free health care. 


Disease cause and prevention is not taken lightly in Cuba.  


Education


The New England Journal of Medicine reported in a 2013 article titled A Different Model - Medical Care in Cuba, "Without a doubt, the improved health outcomes are largely the result of improvements in nutrition and education, which address the social determinants of health." The article also reported that the literacy rate in Cuba is now 99 percent, and extensive health education is part of the mandatory school curriculum. 


The NEJM article also warned its reader not to romanticize Cuban health care too much, since the system is not designed for any consumer choice or individual initiativeThere is no alternative private-payer health system.  


In 1999, the Cuban government was responsible for opening the Latin American School of Medicine (ELAM), possibly the largest medical school in the world (tuition, books, board and a small stipend is provided for free for every student), with an international enrollment reported to be 20,000 students for the six-year medical education program in Havana. The goal is enrolling socially committed physicians from low-income families in developing countries, Africa, Asia and the Americas. The program attempts to put as much emphasis on health promotion as disease management. 


Cuba makes the most out of its medical profession by effectively renting their doctors out to serve abroad, creating a profit of around $6 billion a year, according to research done at the Brighton School of Business and Management in Brighton, England.



Ellen Troyer with Spencer Thornton, MD, David Amess and the Biosyntrx staff 



PEARL

Politics and puffery aside: It seems clear that an open exchange of health care expertise could benefit the citizens of both countries. The obvious question: Should the layers of bureaucracy that feeds off of our health care system dollars and reasonable tort reform, possibly be where the cuts happen instead of Medicare, Medicaid and pre-existing conditions?


An interesting aside: An article published in Forbes suggests that Cuban physicians have provided cataract surgery and other ocular treatments throughout Latin America, restoring vision to almost 3.5 million over the years, and in exchange, receiving political capital, oil subsidies and funding. No mention was made of Cuban rate of poor or successful cataract surgery outcome in developing countries, which should possibly be of concern. 








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