In any rational world, Cuba would serve as an exemplar for restructuring the American healthcare system. But the high concentration of aging Cuban emigres in a state with a pivotal role in presidential elections—Florida—has blinded the U.S. to the reality of a system that works.
Stanford physicians and public health care experts Paul K. Drain and Michele Barry examine Cuba’s medical system and find its focus on primary care medicine rather than specialization to be one of the keys to its success.
In other words, an ounce of prevention really is worth more than a pound of cure:
Despite the blockade, Cuba has achieved better healthcare results than most Latin American countries and comparable with those of most of the developed nations. Cuba’s average life expectancy is the highest (78.6 years) and it also has the highest density of medical doctors per capita—59 doctors to 10,000 people—and the lowest mortality rate for children under one year of age (5.0 per 1,000 live births) and infant mortality (7.0 per 1,000 live births) among the 33 countries of Latin America and the Caribbean.
In 2006, the Cuban government allocated about $355 per capita for healthcare. . .The annual healthcare cost assigned to an American citizen that same year was $6,714
Cuba also assigned less funds to healthcare than most of the European countries. But, the low costs of healthcare do not explain Cuba’s successes which could be attributed to a greater emphasis on prevention and primary care that the island has been cultivating during the American commercial blockade.
Cuba has one of the most advanced primary care systems of the
world. The education of its population in disease prevention and healthcare promotion has made the Cubans less dependent from medical products to keep the population healthy. The opposite happens in the United States which depends highly on medical provisions and technologies to keep its population healthy but at very high economic costs.
Cuba has the highest rates of vaccination in the world as well as the highest number of baby deliveries assisted by expert healthcare workers. The clinical care provided in doctors’ offices, polyclinics and the largest regional and national hospitals are free of charge for patients.
Elsewhere Drain has written:
Cubans have the most accessible health care in the world. Amidst dilapidated buildings, local physician-staffed health clinics, called polyclinics, were deliberately arranged every few blocks throughout the neighborhoods. The polyclinics are as abundant as a Starbucks in Seattle. But, they never close. Furthermore, they don’t even charge their customers a single Cuban Peso.
Each Cuban is scheduled to visit a polyclinic twice a year for a check-up. If a patient fails to make the appointment, a health worker goes looking for them. As a result, Cuba’s rates of vaccinating children and providing safe births are both higher than in the U.S.
More recently, in 1999, after Hurricanes Mitch and George devastated parts of Central America and the Caribbean, Castro took foreign medical assistance to another level. Cuba opened a new medical school, called Escuala Latinoamericana de Medicina (ELAM), to train non-Cubans as physicians. When I visited ELAM, there were 6,000 students from over twenty countries, including the U.S.
“It’s a great program,” a female African-American medical student from Oakland told me. “Our education is totally free. They also give us room and board, and a modest living stipend. I’m very grateful I came here.”
The first American students enrolled in ELAM in April 2002. Since then, 17 young physicians have returned to start their residency training in the U.S. Most American students I met in Cuba were ethnic minorities from disadvantaged backgrounds. They all cited the importance of primary care, as emphasized in Cuba, and planned to return to their neighborhoods of Oakland, Atlanta, and the Bronx to fills gaps left by overspecialized American-trained physicians.
He elaborated on the differences between the medical education systems in an interview with Wired.com:
Starting in 1964, they encouraged all medical school graduates to do at least two years of service in a rural area. That program became so popular that by the mid-1970s, almost all new physicians were doing rural service. From there, almost all medical graduates were channeled into a three-year family medicine residency. That’s where they do clinical training, making the transition to full doctor from medical student.
Almost all their residents do family medicine. They focus on primary care for all ages. Once everybody learns primary care, about 35 percent go on and specialize. It’s quite the opposite of what we have here.
Our medical students choose what they want to do. Only about 7 or 8 percent go into family medicine, which is our primary care system. In Cuba, everyone becomes a primary care doctor. They learn to prevent diseases.
So maybe it’s time this nation considered health care for its citizens as a public service, the same way we do fire and police protection, building inspections, roadway construction, and other aspects of the dwindling commons.
We couldn’t do much worse than we’re doing right now.