In 2016, Cuba made headlines for the status of its economic embargo with the US, its increasing foreign investments through tourism, and the death of Fidel Castro. Besides these recent events, in a sense foreshadowing Cuba’s future political and economic paths, throughout the 20th century, Cuba’s healthcare system has been acclaimed as one of the best healthcare systems in the world with very good health outcomes for the Cuban people. For example, infant mortality is lower than in the US and the life expectancy is 77.5 years of age (WHO, 2016). What are the Cuban healthcare system’s defining features? Will recent events alter some of its key aspects?
Cuba has a universal healthcare system, meaning that all Cubans have access to health services – primary, acute, hospital, dental, eye care – without upfront user fees, no matter their underlying health conditions, gender, or age. Healthcare services are funded by the Cuban central government and administered by state regulated hospitals and health clinics. Three core features further define the Cuban healthcare system: preventive medicine, decentralized care, and a large medical workforce.
Cuba’s healthcare system is largely focused on preventive medicine, which encourages Cubans to develop healthy lifestyle habits (Lowenberg, 2016). This preventive approach translates into positive health outcomes, as evidenced by lower mortality rates, higher life expectancy and lower rates of chronic illnesses. Lowenberg suggests that the emphasis on preventive care can be explained by the fact that Cuba has limited healthcare resources (e.g. screening tools). As a middle income country with fewer importing and exporting activities, physicians must place a greater emphasis on prevention and health promotion.
A second defining feature of the Cuban healthcare system is that it is highly decentralized, meaning that care is localized (Rodriguez, Diaz, Balcindes et al., 2016). Small clinics are found throughout square blocks of Cuban cities and families are assigned to a local physician, making house calls and sustained care possible. It is suggested that this decentralized feature can further aid the focus on preventive medicine.
A last feature of Cuba’s healthcare system is that it has one of the largest medical workforces. Cuba has the world’s highest doctor-to-patient ratio, with about 67 physicians per 10 000 people, whereas in Canada, the ratio is about 24 physicians per 10 000 people (OECD, 2016). To illustrate this difference, Cuba, with a population of 11 million, a third of the size of Canada, has 10 000 more doctors than Canada. It is through the Latin American Medical School (ELAM), one of the largest medical schools in the world, that medical training for Cubans and foreign students is possible. Not only does this workforce serve the Cuban people, but it also serves other countries through medical care contracts, such as more recently with the Ebola crisis (Chaple & Mercer, 2017; Kirk, 2015).
Despite these features, the lack of funding and medical resources, as well as increasing wait times (indicative of most universal healthcare systems such as Canada’s for example), are negatively affecting the Cuban healthcare system. Although in the last decade an effort has been made by the central government to improve the quality of hospitals, resource scarcity has slowed down the process. Furthermore, although there is a significant number of physicians being trained, they are not necessarily caring for Cubans, but rather being sent to the global medical community as they serve as an important source of revenue for the Cuban government. Indeed, about 25% of Cuban doctors work abroad, bringing in 5 billion dollars to the national treasury in 2014 for example (Kirk, 2015). As such, the export of doctors, nurses, and dentists represents an influx of hard currency for the Cuban government.
In closing, a look at the Cuban healthcare system highlights its key features, namely its focus on preventive care and local services, as well as its large medical force, which benefits both the country’s health and economy. However, the quality of the healthcare system has been decreasing as the central government is lacking funds for these services, despite the large number of physicians it produces. With the recent political and economic events that have taken place over the last year, as health services researchers, it will be interesting to follow in parallel subsequent developments to the Cuban healthcare system.
Chaple, E. & Mercer, M. (2017). The Cuban Response to the Ebola Epidemic in West Africa: Lessons in Solidary. International Journal of Health Services. 47(1), 134- 149.
Kirk, J. (2015). Healthcare without Borders: Understanding Cuban Medical Internationalism. Gainsville, Florida: University Press of Florida.
Lowenberg, S. (2016). Cuba’s focus on preventive medicine pays off. The Lancet. 387(10016), 327-329.
Rodriguez, A., Diaz, A., Balcindes, S. et al. (2016). Morbidity, utilization of curative care and service entry point preferences in metropolitical Centro Habana, Cuba. Cad Saude Publica. 32(10).
World Health Organization (2016). Country Profile: Cuba. WHO Online Resources. Retrieved from http://www.who.int/countries/cub/en/
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