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My amazing wife -- mother of 2 and stepmom to my 2, full time employee and full time adult student -- recently wrote a brief paper about the Cuban healthcare system that compared it against key metrics with the system we have here in the United States. I admit I was near speechless with what she found. It is easy to be ashamed of America's general dysfunction on many fronts, basic care of its people perhaps the most glaring. But what really struck me was the thoughfulness and sincerity that seems to characterize the Cuban system.

Maybe you knew, but I certainly did not, that just maybe the model for a caring, efficient and effective healthcare system may be found less than 90 miles south of Florida. Read my wife's short paper below the squigs.  ...And oh, the paper earned an A.


The health care systems of Cuba and the United States were compared, evaluating the cost and efficacy of each system. Cuba maintains a socialist healthcare system has managed to keep healthcare costs among the lowest in the world per capita despite overwhelming adversity (Offredy, 2008). Statistics for overall health are almost equal to the most developed countries like Switzerland and the United States where the costs per capita are the highest. The Cuban system has mastered preventative and proactive family, community and acute care making it one of the most efficient and cost-effective in the world. Although Cubans do not get to choose their doctors, every citizen has an assigned doctor who provides healthcare, unlike the 47 million individuals in the United States who were unwillingly without health coverage in 2007 (Niles, 2011).

Since the 1960s Cuba has faced many adversities with the United States and her allies, such as trade embargos. Combined with the fall of its former patron, the Soviet Union, Cuba was forced to operate its universal goals of healthcare autonomously and with few resources. Prevention through community action and efficiency has become the only affordable way to keep its population healthy (Johnson 2011).

Compare Cuba’s annual per capita spending to the United States in 2005: healthcare spent per capita in Cuba was $260 per capita, while the spending in the United States was 25 times higher at $6,543 (Offredy 2008). This type of discrepancy should yield 25 times better care for the citizens of the United States, but it does not. Standard ways to measure the overall health of a countryinclude infant mortality and life expectancy rates. Cuba is nearly equal to the United Sates in both categories. In 2005, Infant mortality per 1,000 live births is seven in Cuba and 5.3 in the United States and overall life expectancy is 77.6 years in Cuba versus 77.7 in the U.S. (Offredy 2008).

Additionally, Cubans are paying zero dollars out of pocket with extremely high approval ratings of their healthcare (Offredy 2008), at the same time Americans are struggling to keep up with rising  insurance premiums and those who cannot afford to pay for insurance are at risk of financial disaster in case of an accident or major illness in the family. Finally, Cuba’s doctor to patient ratio was 1:158 in 2005 (Offredy 2008) while the ration in the United States was a staggering 1:600 in 2004 (Nair 2004).

The three tier efficiency system of family doctors, specialty clinics and hospitals, which are all interconnected, eliminate inefficiency. First, Cuba educates its brightest and most ethically sound high school students, for free, to be doctors. As a result, in every neighborhood there is a doctor who often knows entire families for many years. The commitment of doctors is apparent since they commonly make house calls if someone misses an appointment, as phones are not commonplace. Every individual gets a check-up twice a year regardless of her health status. The personal relationships Cuban doctors build with patients often lead to early detection of disease, and more importantly, prevention of disease. If the Cuban doctor notices an elderly person becoming depressed he will encourage healthy social behavior like getting involved in community programs that are widely held (Offredy, 2008).

The second tier includes the specialty clinics, or polyclinics, which offer multiple and more formal medical services like rehabilitation, laboratory services, endoscopy and social work.  The polyclinics reduce the incidence of hospital visits and therefore drive costs down. Family doctors ensure the patient has transportation and often accompany the patient to the clinic to personally participate in coordination of care. The entire clinic staff takes on the responsibility of health and prevention education (Offredy, 2008).  

Last resort tertiary, or acute care, at hospitals are open and available with excellent care, but are used only if really needed. Since the patients had care prior to being admitted, a doctor already knows the condition of the patient and is able to validate whether hospitalization or acute care is necessary (Offredy 2008).  In the U.S. people end up using hospital emergency rooms as their primary care because they cannot be refused care if it is an “emergency” (Niles, 2011).

Cuba’s Che Guevara (also a physician) had a vision to provide excellent preventative healthcare to every citizen in 1960. Finally in 1984, Cuba initiated the Family Doctor Programme where the goals are mainly preventative medicine, teaching and research (Offredy 2008).  Despite major obstacles like a lack of supplies and a weak economy, Cuba forged ahead with its plan. Placing readily accessible doctors in every community increases the efficiency of care and it works. It is currently considered one to the healthiest countries in the world (Johnson 2011).

Pajoly note: One last thought I want to leave you with. However we manage to evolve our hideous system, one thing that must end: A dying child must not be a profit opportunity.

Fawthrop, T. (2003). Health for export. New Statesman, 132(4665), 32. Retrieved from EBSCOhost.
Hood, R. J. (2000). Cuban system offers an uncommon opportunity. Journal of the National Medical Association. Retrieved from
Johnson, T. (2011). APHA members travel to Cuba for insight on health strategies. Nation's Health, 41(2), 6. Retrieved from EBSCOhost.
Nair, S. (2004). Doctor shortage facing the U.S.. College Media Network. Retrieved from
Offredy, M. (2008). The health of a nation: perspectives from Cuba's national health system. Quality in Primary

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Comment Preferences

  •  Why? (3+ / 0-)
    Recommended by:
    johnny wurster, Lujane, erush1345

    A population about the size of NYC. So doing something for the entire population is a bit easier. Hence like VT we will probably see more progress on the state level towards single payer than at the National level. At least in states where they  actually care about the citizens and care about the out of control cost of healthcare.

    A centralized socialist/communist government that has none of the restraints of a representative democracy. In other words the government wants to do something it just does it. They control the price of everything associated with healthcare. Doctors work for the state and hospitals are owned by the state.

    In the choice between changing ones mind and proving there's no need to do so, most people get busy on the proof.

    by jsfox on Sat Jul 09, 2011 at 07:26:15 AM PDT

    •  Thanks, I understand the issues and (4+ / 0-)

      ...the diary title is a bit rhetorical. Given that it is a small island nation, the disparity in both cost and effectiveness is still remarkable. Also, perhaps the key element has nothing to do with its socialist nature so much as its focus, which is centered on prevention.

      It is this laser focus on prevention -- perhaps out of necessity -- that really marks the distinction between our systems. I'd contend that even in single payer system, if we do not likewise focus on prevention our per capita costs would still be higher relative to a prevention-aligned system.

    •  sounds good to me (0+ / 0-)
      Doctors work for the state and hospitals are owned by the state

      Burdening doctors with the additional responsibility and distraction of also being businesspeople is doubly dysfunctional:  those who want to focus on care get distracted while those who want to game the system for $$ have a field day.  A doctor should be a salaried position with patient care the only concern.

      Scientific Materialism debunked here

      by wilderness voice on Sat Jul 09, 2011 at 12:21:35 PM PDT

      [ Parent ]

  •  Your wife might be interested in (2+ / 0-)
    Recommended by:
    truong son traveler, Lujane

    this book.  Though it's a little bit old (1993), it provides a comprehensive analysis of how and why Cuban health got to where it was some twenty years ago.

    And, of course, where it is today depends on where it was before...

    ¡Boycott Arizona!

    by litho on Sat Jul 09, 2011 at 07:27:29 AM PDT

    •  thanks for this (3+ / 0-)
      Recommended by:
      phonegery, Lujane, gooderservice

      My wife works in a major non-profit trauma center hospital, though not on the clinical side. As a financial analyst, she does though daily deal with the insanity and vulgarity that is the insurance cartel. These criminal entities frankly threaten the survival of hospitals like hers.

  •  I am very familiar with Cuba's health care system. (11+ / 0-)

    I lived in Cuba for 4 years while my (non-American) husband was posted at an embassy there.  Both of my children were born by c-section in Havana at the Gonzalez Coro hospital in the Vedado neighborhood.  My older son was immunized in Cuban clinics.  

    My assessment of the health care system is mixed.  It can be summed up best this way:  until very recently, Cuban doctors are some of the best in the world and the lack of hi-tech equipment helps make them so.  There is very good access to necessary medication for diabetics and people with asthma, as well as general antibiotics.  Much attention is paid to vaccines and to education on nutrition.  However, the physical condition of most hospitals and clinics is atrocious and most miss the basic necessities.  For hospital stays, patients generally bring these necessities from home (sheets, towels, toilet paper if they can afford it, soap, and food), and are often forced to buy disposable syringes, surgical tape and even sutures on the black market.  

    One of the reasons health care per capita is so inexpensive is that doctors are paid $20-$30 per month.  If they would like to make more--$50/month--they may request an international mission such as Operacion Milagro in Central America, or in Angola.  When they return, they are also given the privilege of being able to buy a car, again if they have the money.  

    I miss my Cuban doctors very much.  They are among the most altruistic people in the world.  Most, though, have to take on second jobs in order to make ends meet.  One doctor and university professor with whom I became good friends made money on the side doing professional massage for the diplomatic community in Havana.  He is very worried about the younger generation of medical staff (particularly nurses) who are being pushed into the profession too early without the proper training.  There is little financial incentive to do these jobs, a problem that is about to become much worse now that Raul Castro has permitted people to get licenses to do work independently (cuenta propistas).  

    I think there are many reasons to admire the Cuban health care system, but I fear that it is often idealized, as it was in Michael Moore's "Sicko".  

    I'd be happy to answer any questions about Cuban health care that I can.

  •  Free medical school Not just for cubans (6+ / 0-)

    Here Is a link. My daughter starts this fall. 7 years of school. 1 year Spanish and science, 2 years medical in classroom,  4 years as an intern with the last year as a supervising intern. She is very excited.

    wiki link

    Extraordinary Claims require Extraordinary Proof.: Carl Sagan

    by zipn on Sat Jul 09, 2011 at 07:45:26 AM PDT

    •  I met some American residents of the med school (2+ / 0-)
      Recommended by:
      Lujane, wilderness voice

      while I was hospitalized for gestational diabetes with my 2nd child.  They seemed to be really happy with the program.

    •  How does that work? (2+ / 0-)
      Recommended by:
      gooderservice, wilderness voice

      I am interested in understanding how she accessed this opportunity. All my girls are in a Spanish immersion program (and have been since pre-school). My oldest is near fluent now at 10. (I don't speak a lick of Spanish.) I will be trying to encourage them to go to college outside the U.S., at least in part.

      •  The wiki post sums it up pretty good (3+ / 0-)

        The candidate selection is done out of New York. The applicant has to commit to serving the under-served in their community when they finish the program, but there's no contract as such. They do a good job vetting the students making sure that they are serious about the commitment. They focus on the under-privileged.

        Our daughter lives independent from us, and is working for relatively low wages in admitting at an E.R. She did great is college and has two degrees including bio-chemistry. I think her science background, excellent academics, and her working-poor status along with her history of volunteering helped her qualify. My brother called her a "One-woman peace corps" one time.

        She is good with Latin, but not Spanish, so she goes an extra year to get fluent before the actual med school begins. The Latin will help, but being fluent in Spanish is a positive thing.

        The real key is that your daughter is willing to work hard under relatively sparse conditions for 6 years, and will absolutely commit to working in under-served communities when they graduate.

        Have her check out the links from the wiki site, and contact the group in NY for more info.

        We're very very proud of our daughter and know that she'll do good there, and will be a great doctor when she's done.

        Extraordinary Claims require Extraordinary Proof.: Carl Sagan

        by zipn on Sat Jul 09, 2011 at 08:42:08 AM PDT

        [ Parent ]

  •  Our costs for health care are similar to Cuba here (5+ / 0-)

    in 3rd World SE Asia. We do it by paying technicians less than US$10 per day, nurses less than US$15 per day, and doctors less than US$50 per day. My guess is that Cuba uses this system. There is no way to transfer this system to the USA.

    I voted with my feet. Good Bye and Good Luck America!!

    by shann on Sat Jul 09, 2011 at 07:47:38 AM PDT

  •  It isn't only the dying child seen as a profit (2+ / 0-)
    Recommended by:
    SneakySnu, wilderness voice

    opportunity, it is every patient seen as a profit motive.  What can I sell that makes me the most money?  I read an article about a man who took a minor shoulder problem to physicians in 3 countries.  In Greece the doctor said it was a minor problem.  In England the doctor gave him a set of exercises. In the US they wanted to sell him an $85.000 shoulder replacement.

    I just learned about US medical mentality.  4 years ago I had my first geriatric  problem with swollen ankles.  I went to a vein clinic and was told I had lymphedema and told to wear compression socks. Recently I went to one of 4 lymphedema clinics in the country, one being in Grand Rapids.  There I was told it was not lymphedema but chronic vein insufficiency.  I said I go to a vein clinic and it is lymphedema and I go to a lymphedema clinic and it is veins, what is going on?

    I got an honest answer, he said it was a matter of semantics and that the vein doctor was a cutter and there was nothing he could do for me so he just wanted me out of his office as quick as possible.  What I have is far less serious than the original diagnosis and I do not regard that doctor as an honest man.  Multiply that by every "Capitalist" doctor in the country and we get to spend twice as much per capita as England, Canada and Japan for far less than their universal coverage.  Way to go, once great USA.

    Tea Parties are for little girls with imaginary friends.

    by J Edward on Sat Jul 09, 2011 at 08:27:31 AM PDT

    •  The doctors do more with less (1+ / 0-)
      Recommended by:
      wilderness voice

      - I understand there is an emphasis on more old-school diagnostics than just relying on high-tech ct scans and MRIs. Cuban doctors are supposed to be some of the best hands-on all around diagnosticians there are. They practice complete medicine, working with patients, not just symptoms.  I bet if they had GE take over their hospitals and sell them all that high tech stuff, they'd use it, and I am sure they are not ignorant of the technology, but without access to it all, they're forced to learn and practice medicine the old-fashioned way.

      I do hope that it won't be long before the whole US vs CUBA thing dies away.

      Cuba's political and social-economic situation, and our Cuban policy are relics from the cold war. Time for all of us to join the 21st century in that regard. Cuba needs to become democratic, and the US needs to stop treating them like they're a threat to us.

      Plus, I want to buy one of their 55 Chevys so I can paint it primer grey and hot rod it :)

      55 Chevy in all it's glory

      Extraordinary Claims require Extraordinary Proof.: Carl Sagan

      by zipn on Sat Jul 09, 2011 at 08:52:28 AM PDT

      [ Parent ]

  •  Sure, the same was in Soviet Union and (1+ / 0-)
    Recommended by:
    johnny wurster

    to an extent still is in most of its successor countries. As other commenters said, it's low doctor and nurse salaries, lack of high-tech equipment and universal healthcare. The system where you're assigned to a primary care doctor is a good one b/c this way you can go to this doctor instead of emergency room (unless you have a real emergency). But you can't choose a primary care doctor so if you get a bad one, you're stuck.

  •  Neighborhood docs (1+ / 0-)
    Recommended by:
    wilderness voice

    I've visited Cuba 7 times and have a number of friends there who work in health care. Basically the lowest-tier care is that you are assigned to a primary-care doc in your neighborhood. That person has a relatively low caseload and gets to know everyone pretty well. (I asked one whether they test everyone for HIV -- she said "no, we pretty much know whose lifestyle puts them at risk." Privacy is an unknown concept.) So a lot of the issues we struggle with -- access to someone to answer the low-level questions especially "after-hours," someone to help people stay on their meds, factoring in social and economic risks -- are built in.
    In addition, the docs are on salary (too low, they complain) and no one has a vested interest in up-selling or prescribing anything that isn't really needed. If anything, there's a feeling to preserve scarce resources like hospital beds for the people who really need them.

    It would take a complete revolution to replicate anything like this in the US. That said, the neighborhood health clinics in the Obama plan begin to move in that direction, if they survive the backlash. So do the incentives to convince med and nursing and NP students to go into primary care instead of speciaties.

  •  It should be remembered that Cubans (2+ / 0-)
    Recommended by:
    Utahrd, SneakySnu

    generally walk several miles a day.

    They get a good amount of exercise.

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