What we can learn from Cuba's health care system
How does an impoverished country succeed in keeping its citizens healthy?
Thu, Jun 27 2013 at 12:16 PM
The correlation between low income and poor health has been established in many countries. Yet despite Cuba's poverty, the country’s quality of health bucks this trend.
According to the United Nations Human Development Report, Cuba has the same life expectancy as the U.S. and a lower maternal mortality rate when compared to other countries in the region. A paper published in the International Journal of Epidemiology found Cuba has eliminated several common diseases, including diphtheria, measles, pertussis, rubella and mumps. What is the secret to Cuba's success? Here are a few aspects of the Cuban health care system that Americans could adopt.
Community-oriented primary care
Universal care and good access to care are two factors that contribute to the success of Cuba’s health care system. According to research published in the Journal of the American Board of Family Medicine, the majority of care is provided by neighborhood clinics, called consultorios. A typical doctor will care for about 120 to 160 families, and medical records are organized around families, putting greater emphasis on communities rather than viewing each patient as an isolated individual. Doctors see patients at the clinic in the morning and make house calls in the afternoons.
"Doctors in Cuba do a good job of making sure that patients are getting the care they need," said Dr. Lee T. Dresang, a family practitioner who teaches at the University of Wisconsin School of Medicine and Public Health. "They typically spend half of the day out in the community."
Dresang traveled to Cuba to learn about the health care system and is the lead author of the 2005 paper "Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine," which was published in the Journal of the American Board of Family Medicine.
Since then, some providers in the U.S. have taken small steps toward this type of primary care, with the creation of primary care medical homes. These organizations aim to focus health care on successful outcomes — healthier people — rather than on volume.
The clinic where Dresang works has become a certified primary care medical home, which means the doctors, nurses and technicians have daily meetings and are working more closely together to coordinate each patient's care.
"It's been really nice for us to see the benefits it can have," said Dresang.
Acceptance of alternative and complementary medicine
Since the trade embargo was placed on Cuba, it has been difficult for doctors to access pharmaceuticals that are common elsewhere. This has encouraged the widespread use of complementary and alternative medicines, such as acupuncture, massage and heat therapy. Alternative medicine practices are integrated into the medical curriculum in Cuba.
"Most family physicians in Cuba practice some herbal medicine, also known as 'green medicine,'" Dresang writes. "A national formula and educational materials on green medicine are distributed to all practitioners by the Cuban Ministry of Public Health."
Homeopathy is also widely practiced in Cuba. One of the most interesting examples of its application is the widespread treatment of Weil's disease, which often flares up during the rainy season because it is transmitted via water. A large-scale study found that Cubans' risk for contracting the infection could be reduced with doses of the bacteria in a highly diluted solution.
In light of how many people seek complementary and alternative medicine from non-medical practitioners, Dresang wants "greater familiarity" with these treatments in the U.S. Since 2005, Dresang said, interest in these practices has grown among doctors. More medical programs are offering courses in alternative medicine disciplines, and the University of Wisconsin has an alternative medicine fellowship. "It's a national trend," Dresang said, adding that med students may even seek training in these fields outside of the established curricula.
Of course, not every aspect of the Cuban health care system is worth adopting. The U.S. and Cuba have very different populations, and research into specific alternative medicine therapies is needed before they should be recommended more widely. Nonetheless, a country that made do with fewer technological and monetary resources for decades and still has such positive health outcomes is remarkable. Cuba's example offers a wealth of potential new treatments and approaches to explore.
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