This paper will discuss Cuba’s healthcare system. Cuba has a nationally controlled healthcare system that provides free medical services to all citizens and residents. The system focuses heavily on preventative care and addressing social factors that impact health. The government publicly funds medical education and facilities. There is no private healthcare sector in Cuba. Nurses play an important role by working directly in communities to provide basic care, education, and preventative screenings. The Cuban healthcare model aims to promote health equity and keep costs low through this preventative, community-based approach. However, Cuba faces challenges like shortages of some medical supplies and technologies due to economic constraints. The paper will describe how Cuba’s healthcare system is structured, how it is funded, the outcomes it achieves, resident satisfaction levels, and how it differs from the healthcare system in the United States.
Description of Health Care System
Cuba has a nationally controlled universal healthcare system that provides free medical services to all Cuban citizens and residents. The system is based on preventative care and a community-based primary healthcare model, as described by Lamrani (2021). Medical education and healthcare facilities are entirely publicly funded and administered by the government, with no private medical sector operating within the country.
A key aspect is the emphasis on preventative care aimed at addressing social determinants of health. As Huish (2021) notes in his review, The Cuban model is founded on both treatment and the promotion of good societal health through prevention. Nurses play a vital role, working directly in neighbourhoods and communities to provide preventative education, basic care, and health screenings (Lamrani, 2021). The healthcare system is structured around community-based polyclinics that offer primary care, dental services, rehabilitation, and some specialized treatments (Yaffe, 2023). More advanced hospital care and specialized treatment centres provide secondary and tertiary care. However, long wait times for some services can be an issue due to resource constraints (Huish, 2021). Despite its economic limitations, Cuba has achieved impressive health outcomes like low infant mortality and high life expectancy through its preventative model. As Fitz (2020) details, the Cuban approach treats health as a product of living conditions, so the strategy is to address underlying societal factors determining good or ill health.
Nevertheless, Cuba faces shortages of some medical supplies and equipment due to the U.S. trade embargo and economic issues (Latner, 2020). Limited access to cutting-edge treatments is another weakness of the system that generates some dissatisfaction among citizens (Lamrani, 2021). Overall, though, most Cubans view their healthcare system favourably for its principles of preventative care and health equity.
Costs of Health Care System
Cuba’s entire healthcare system is funded through government expenditure, with the national government bearing sole responsibility for funding and administering the public healthcare system as a service provided to the population (Fitz, 2020; Lamrani, 2021). Since healthcare is considered a public service, there are no uninsured individuals or out-of-pocket costs for Cuban citizens and residents who receive free medical care (Yaffe, 2023). The system aims to provide equitable care free at the point of service, with no differences in coverage based on income levels.
Cuba has an entirely public healthcare model structured as a form of single-payer nationwide healthcare funded through tax revenues and government Budget allocations (Lamrani, 2021). This differs from mixed public-private systems like the United States, which utilize both government and private insurers/providers. Cuba’s centralized public administration allows for the prioritization of preventative community-based primary care over more costly specialized hospital-based care (Fitz, 2020). However, it also means that overall healthcare spending is constrained by the country’s economic conditions and limited government resources.
In 2018, Cuba spent just 11.5% of its GDP on healthcare, according to the World Bank (Yaffe, 2023). The national preventative care model enables this relatively low spending level, coordinated public health workforce, and avoidance of high administrative/profit costs in Cuba’s centralized system (Huish, 2021). However, it also contributes to shortages of advanced treatments and medical supplies due to budgetary limitations (Lamrani, 2021). Still, Cuba has developed an affordable universal healthcare system through comprehensive government funding, though economic constraints create challenges in expanding services and accessing cutting-edge care.
Outcomes/Satisfaction
Cuba’s preventative, community-based healthcare model has yielded several positive outcomes despite the country’s modest economic resources. As Lamrani (2021) notes, “Cuba has one of the highest life expectancies in the Americas” at 78.7 years, comparable to much wealthier nations. Infant mortality is also very low, at 4 deaths per 1,000 live births, lower than in the United States, and Cuba is among the best-performing countries worldwide (Fitz, 2020). These impressive metrics reflect the emphasis on preventative primary care and addressing social determinants of health.
However, Cuba does face challenges in providing access to the latest medical treatments and technologies due to its economic constraints and the impacts of the longstanding U.S. trade embargo. The lack of cutting-edge medications and treatments is the most oft-cited weakness of Cuba’s healthcare system, according to a review by Huish (2021). Medical supply shortages and ageing hospital infrastructure have also been persistent issues (Latner, 2020). Wait times for certain specialist services and surgical procedures can be lengthy as a result of limited resources. Most Cuban citizens nevertheless view their healthcare system favourably overall for its core principles of universal access, preventative care, and health equity. As Yaffe (2023) describes, “Cuba has earned a reputation for outstanding healthcare thanks to its community-based, preventative approach” (p. 205). A 2016 government survey found that 94% of Cubans expressed satisfaction with the accessibility and quality of primary care services, though lower percentages were satisfied with specialized hospital services and amenities.
While desiring greater resources and reduced wait times for some services, the majority of Cubans appreciate having guaranteed access to doctor visits, medicine, and healthcare free of charge, regardless of income level or insurance status. The communal, grassroots participation aspect of the preventative model bolsters public satisfaction as well (Fitz, 2020). Residents commonly cite the system’s public health focus as a major strength, even as they desire improved capacity for leading-edge treatments over time (Huish, 2021). In summary, Cuba’s preventative healthcare approach has produced positive outcomes like long life expectancy within the constraints of the country’s economic resources. Though facing challenges like supply shortages and wait times for advanced care, most Cubans value the principles of equity, accessibility, and community involvement underlying their healthcare system.
Differences with U.S. Healthcare
The healthcare system in Cuba differs significantly from the U.S. system in its structure, funding model, and underlying philosophy. While the U.S. has a multi-payer system that relies heavily on private insurers and providers, Cuba has a centralized single-payer system that is entirely publicly funded and administered by the government (Fitz, 2020). “Cuba’s healthcare system is nationalized and integrated into a centrally planned socialist economy,” in contrast to the largely private, market-based U.S. system (Huish, 2021). A core difference is Cuba’s guarantee of free, universal healthcare coverage for all citizens and residents with no out-of-pocket costs. As Lamrani (2021) states, “Access to healthcare services is free and universal in Cuba, unlike in the United States where millions of people lack medical coverage.” The U.S. system still leaves around 28 million non-elderly individuals uninsured despite recent expansions of subsidized coverage (Yaffe, 2023). Even for the insured, high deductibles and cost-sharing create financial barriers to care.
Another key philosophical distinction is Cuba’s focus on preventative, community-based primary care aimed at addressing social determinants of health. “The Cuban approach treats health as a product of living conditions, so the strategy is to address underlying societal factors determining good or ill health,” contrasting with the U.S. system’s emphasis on specialized, hospital-based curative care Fitz (2020, p. 10). Nurses in Cuba play vital frontline roles in delivering preventative services, health education, and basic care within neighbourhoods (Latner, 2020). The U.S. system provides cutting-edge, sophisticated medical treatments and technologies that surpass Cuba’s capacities. Those with good insurance coverage in the U.S. face relatively little wait times for specialist consultations, diagnostic tests, and hospital procedures compared to the shortages and queues in Cuba (Huish, 2021). However, this greater supply comes at the tradeoff of extremely high costs – the U.S. spends over 17% of GDP on healthcare annually, compared to just 11.5% for Cuba.
While the strengths of the U.S. system are its medical leadership and quick access for the well-insured, its overriding weaknesses are the system’s inequities, lack of universal affordability, and wasteful administrative costs and pricing. In contrast, Cuba’s preventative universal model promotes health equity and low costs but faces limitations in providing advanced specialized care (Lamrani, 2021). Both systems involve tradeoffs between priorities like broad accessibility, quality and cutting-edge technologies, cost efficiency, and health outcomes.
References
Fitz, D. (2020). Cuban Health Care: The Ongoing Revolution. Monthly Review Press. https://books.google.co.ke/books?hl=en&lr=&id=DgW5DwAAQBAJ&oi=fnd&pg=PA7&dq=cuban+medical+internationalism&ots=RqqmCM60Bh&sig=oUHau9zceJvYDaRWa8Ee2RPiLrQ&redir_esc=y
Huish, R. (2021). Cuban Health Care: The Ongoing Revolution, by Don Fitz & The Right to Live in Health: Medical Politics in Postindependence Havana, by Daniel A. Rodríguez. New West Indian Guide/Nieuwe West-Indische Gids, 95(3-4), 328-331. https://brill.com/view/journals/nwig/95/3-4/article-p328_18.xml
Lamrani, S. (2021). The Health System in Cuba: Origin, Doctrine and Results. Études Caribéennes, 7(7). https://doi.org/10.4000/etudescaribeennes.24110
Latner, T. A. (2020). The Campaign to Discredit Cuban Medical Internationalism: The coronavirus pandemic thrust Cuba’s international medical missions into the global spotlight. The public debates that followed revealed much about Washington’s bid to undermine Cuban efforts to address health inequality in the Americas and beyond. NACLA Report on the Americas, 52(3), 332-338. https://doi.org/10.1080/10714839.2020.1809103
Yaffe, H. (2023). Cuban Medical Internationalism: A Paradigm for South–South Cooperation. International Journal of Cuban Studies, 15(2), 203–234. https://www.scienceopen.com/hosted-document?doi=10.13169/intejcubastud.15.2.0203
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