Last week there was an article in the New England Journal of Medicine that stated admiration for the Cuban healthcare system - A Different Model –Medical Care in Cuba. This is a noteworthy event for many reasons.
From the political to the economic, Cuba and the USA are at opposite ends of many scales. Cuba is one of the poorest socialist countries in the world while the USA is among the wealthiest capitalist countries. But they do share a critical statistic. Their populations have similar longevity rates, with Cuba slightly ahead. People in Cuba have a life expectancy at birth of 78.50 years - 76.35 for men and 80.52 years for women. Life expectancy at birth in the USA is 77.97 years - 75.35 for men and 80.51 for women.
However the two healthcare systems are almost diametrically opposed to each other. The Cuban system is among the least expensive in the world. It has among the lowest numbers of hospital beds per population. The care is focused around primary care with each doctor serving about 1000 patients with the support of a mixed health team. Patients are all rated according to their level of health. Every patient is visited at home at least once a year, and patients at higher risk are visited more frequently. There are polyclinics which provide specialty care and, as I said, very few hospitals. As a result, care is given to keep people healthy and also to avert hospitalization as much as possible. Cuba has a much higher ratio of primary care doctors to population than the USA or Canada. It exports doctors throughout South America. And its hospital care is still relatively good by South American standards, so much that Hugo Chávez left Venezuela to be treated for cancer in Cuba.
The New England Journal applauds the organization of care in Cuba and suggests that it would be in our interest to learn what we can from that system. The late Barbara Starfield, noted Johns Hopkins University advocate for primary healthcare, argued that Cuba provided better and safer care to its population than did the sophisticated American system. She was one of the earliest to argue that hospitals in the USA are a dangerous place, and to conclude that vastly improved primary care is a solution to the problems of American healthcare.
I believe that Cuban medicine might be interesting to look at for Canada. Large areas of the country would be best served by concentrated primary care services. It allows for small population medicine at the highest level and can provide better more personalized care at a lower cost and with better outcomes than we have now.