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Which healthcare system would you rather work in: Cuba or USA?

Just 90 miles separates Florida from the Cuban coast. When it comes to healthcare systems though, these two nations are worlds apart … who’s got it right?

David v Goliath: Some Key Healthcare Statistics

If you look at a recent world life expectancy table, there are few surprises. Right at the top sits the millionaire’s paradise of Monaco, where you’d be considered unlucky not to reach your 90th birthday. Languishing at the bottom is Chad, a country still desperately trying to pull itself together after years of civil war – and where life expectancy is less than 50 years.

Life expectancy varies worldwide (image: www.dailymail.co.uk)

Life expectancy varies worldwide (image: www.dailymail.co.uk)

Money talks, and the richer and more stable a country is, the greater the likelihood of it being able to build up a quality healthcare service. One of the subjects looked at in detail by students on the Diploma in Healthcare Management online distance learning course from BrightonSBM is international healthcare policy and the way in which various aspects from national resources through to cultural and religious beliefs combine to shape a country’s healthcare system.

If you didn’t know any better, you wouldn’t put money on Cuba having a world-class healthcare system. After all, the country has been under a US-imposed trade embargo for 54 years and lost its main trading partners with the collapse of the Soviet Bloc more than a decade ago. The bare economic figures for the country don’t look too promising either: annual GDP per capita based on 2011 figures is US$6,106. By contrast, the same figure for Cuba’s big neighbour across the Gulf of Mexico is $47,882.

The Americans are the world’s biggest spenders when it comes to healthcare. The figure spent per person each year is $8,362. Cuba spends $431.

How much does Cuba spend on health? (image source: www.theguardian.com)

How much does Cuba spend on health? (image source: www.theguardian.com)

On this basis alone, you’d probably expect a big gulf between Cuba and the US when it came to life expectancy. In fact, they’re incredibly close. Life expectancy in the United States is 78.49 years – whereas for Cuba it’s 77.87 years. A key indicator for the effectiveness of a nation’s healthcare system is infant mortality rate. On this, Cuba actually does better than the US according to the World Bank.

How did Cuba get such an effective healthcare system?

Why does Cuba have health stats that are closer to the likes of Denmark and Singapore than its Caribbean neighbours such as Haiti and Jamaica?

What went so right with Cuban healthcare?

What went so right with Cuban healthcare?

 Building a ‘New Jerusalem’

Start from scratch: that’s perhaps one of the most important lessons for any nation seeking to build a new healthcare system. A good time to do it is when the country’s in the process of reorganisation, something that was definitely happening to Cuba in the 1960s.

Cuba offers a national healthcare system and all services are run by the state. In this respect, the Cuban system shares many broad characteristics with the UK’s National Health Service (NHS). As Healthcare Management students learn, aspects of the UK’s NHS have been reorganised to create an internal market, which in some ways mirrors the private sector. Nevertheless, the broad principle is that treatment is free at the point of delivery: patients don’t get a doctor’s bill.

Cuban nationals don't have to worry about healthcare bills

Cuban nationals don’t have to worry about healthcare bills

Similarities with Britain’s National Health Service!

There are also some similarities in the ways the two healthcare systems came about. Even in the relatively early stages of the Second World War, the British Government asked William Beveridge to draw up a blueprint for a welfare state. A key part of this was the idea that the state would take direct responsibility for the nation’s health.

Many doctors were against the idea – as were a lot of the ‘friendly societies‘, voluntary organisations and other bodies that were responsible for healthcare before the NHS was created. The fact that there had been huge upheaval caused by the War meant it was much easier to build a general consensus among the relevant vested interests and the general public as a whole – based on a grand vision to create a ‘new Jerusalem’. The UK was undergoing the sort of fundamental restructuring that allowed Cuba to rebuild its healthcare service too.

Increase in mortality following the Cuban revolution

Increase in mortality following the Cuban revolution

Following the Cuban Revolution (1953-9) disease and infant mortality increased, so that in the 1960s the new communist leadership decided to make healthcare a state priority. Che Guevara (himself a doctor by training) set out a 3-pronged approach:
… to provide public health services to the greatest number of persons, institute a programme of preventative medicine, and orient the public to the performance of hygienic practices“.

Do you need a revolution to get a better healthcare system?

Try and transform (or even tinker with) an existing healthcare system without a major impetus for change and a government can get into major trouble. We’ve seen this most recently with President Obama’s attempts to pass the Affordable Care Act (otherwise known as Obamacare).

Barak Obama’s ‘Affordable Healthcare’ Bill has not been widely appreciated in the US<br>(image: Pete Souza, wikipedia.org)

Barak Obama’s ‘Affordable Healthcare’ Bill was not widely appreciated in the US (image: Pete Souza, wikipedia.org)

By no means was this an attempt to revolutionise the American healthcare system: it was essentially a way to make it easier for people to get subsidized health insurance as well as bringing in better regulation of the insurance industry. It got through; but not without bringing government to a standstill.

Indonesia’s managed a total overhaul recently without a revolution. In a country where a third of the population live under the poverty line, this year saw the introduction of a system providing millions with free healthcare. It’s still early days for Indonesia, but it can be done!

Indonesia now has a universal healthcare system

Indonesia now has a universal healthcare system

Prevention is better than cure

For 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. There is also a heavy emphasis on primary care with one GP per 785 people, and 35 per cent of doctors in Cuba specialise in primary care whereas in the US the figure is 7 to 8 per cent. Extensive outreach programmes play an important role in helping to prevent disease; HIV prevalence for instance is certainly the lowest in the Americas – and actually one of the lowest in the world.

Keeping your doctors in the country

This is perhaps the most controversial aspect of the healthcare system (and the society as a whole). Medicine and healthcare management with its transferrable skills, are global professions. Last year was the first time since 1961 that Cuban citizens were allowed to leave the island without an exit visa.

Cuba scraps exit visas (photo: European Pressphoto Agency)

Cuba scraps exit visas (photo: European Pressphoto Agency)

Even after that, there remain tight restrictions on medics and key professionals. The state certainly makes the most out of its medical profession by effectively renting them out to serve abroad (at a profit of around $6 billion a year to the state). If a doctor decides he wants to up sticks and take up a permanent post abroad though, he would find it pretty much impossible.

Is keeping absolute control over movement of capital and individuals ‘worth it’ if it helps secure an effective healthcare system?

Is it possible – or necessary – to provide healthcare for all?
Or is it just a foolish dream?

What do you think?

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