Does more money mean better health? A look at Cuban healthcare

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One of the SERMO physicians practicing in the UK recently took a trip to Cuba.  While there, he visited a Cuban village health clinic and shared his thoughts on Cuban healthcare with the community.

Earlier this year I fulfilled an ambition to go to Cuba. I wanted to get there before a lot of what makes it special is ‘spoiled’ by restoration of diplomatic relations with the US – leading to future lifting of trade sanctions.

It’s odd, but a rather large proportion of the population are happy with the status-quo – if you ask them (I did).

During my time there, I got to visit a Cuban village health clinic.

On one hand I was struck by how basic some of the equipment was. Unsurprising given the economic embargo. But still shocking for someone used to 1st World Healthsystem and supplies.

On the other hand, I was equally amazed at what is achieved with those limited resources.

The primary prevention there is on another planet. I was staggered to see that the vaccination system rivals and indeed betters that of many European (and ?US) countries. In the UK we’re still arguing over the price of Meningitis B vaccine and whether the cost is worth a few kids dying a year because of it. In Cuba, it’s part of the programme already – see the chart below for the vaccine schedule.

In the village I went to, whilst they don’t have EPRs, what they do have is a detailed knowledge of each and every villager including their specific healthcare needs – how many are pregnant, how many have alcohol issues etc. That is equivalent to many of our expensive GP / Primary Care databases – and for a fraction of the cost.

The drugs they have are limited, yet therefore they are used much more appropriately – for those that really need them. Less wastage. Each pill is counted and cherished.

It’s not just the equipment, but the personnel. According to the W.H.O., Cuba has 6.7 doctors per 1,000 people – that’s 1 doctor for every 150 people. The US – 2.4 per 1,000. The UK can’t beat that either – 2.8 per 1000. In fact only Monaco and Qatar can – in the world. To beat the economic embargo, doctors are exported as ‘people-currency’ to Mexico etc.

Life expectancy (average 78.1 years) is the same broadly as the US (average 78.6 years) – staggering when you consider what the US spends in healthcare – and vividly illustrates what a waste of money is a lot of what ‘developed countries’ call ‘vital’ healthcare.

An obvious negative difference is infant mortality (which is still high in Cuba) – unsurprising given the lack of Intensive Care and Level 3 facilities for the most critically ill babies. But once you make it through the early years, you’ll do OK.

So, in summary, more money most definitely does not equate to ‘better’ health – necessarily.

Good primary prevention can offset the huge sums later required for secondary and tertiary care treatments.

Food for Thought?!

 

If you’re a physician, please join us inside SERMO as we continue to discuss this and other topics.

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