Sunday, August 26, 2012

Cuba campaign takes on 'free' health care

Posted on Saturday, 08.25.12

Cuba campaign takes on 'free' health care
Associated Press

HAVANA -- Cuba's system of free medical care, long considered a
birthright by its citizens and trumpeted as one of the communist
government's great successes, is not immune to cutbacks under Raul
Castro's drive for efficiency.

The health sector has already endured millions of dollars in budget cuts
and tens of thousands of layoffs, and it became clear this month that
Castro is looking for more ways to save when the newspaper voice of the
Communist Party, Granma, published daily details for two weeks on how
much the government spends on everything from anesthetics and
acupuncture to orthodontics and organ transplants.

It's part of a wider media campaign that seems geared to discourage
frivolous use of medical services, to explain or blunt fears of a
drop-off in care and to remind Cubans to be grateful that health care is
still free despite persistent economic woes. But it's also raising the
eyebrows of outside analysts, who predict further cuts or significant
changes to what has been a pillar of the socialist system implanted
after the 1959 revolution.

"Very often the media has been a leading indicator of where the economic
reforms are going," said Phil Peters, a longtime Cuba observer at the
Lexington Institute think tank. "My guess is that there's some kind of
policy statement to follow, because that's been the pattern."

The theme of the Granma pieces, posters in clinics and ads on state TV
is the same: "Your health care is free, but how much does it cost?"

The answer is, not much by outside standards, but quite a bit for Cuba,
which spends $190 million a year paying for its citizens' medical bills.

Based on the official exchange rate, the government spends $2 each time
a Cuban visits a family doctor, $4.14 for each X-ray and $6,827 for a
heart transplant.

It's not a luxury service though. Scarcities now are common and sanitary
conditions fall short of the ideal in decaying facilities where paint
peels from the walls. Patients often bring their own bed sheets,
electric fans, food and water for hospital stays.

One Havana-based clinical physician applauded the campaign, saying it
targets a pervasive problem: Conditioned to think about health as an
inalienable right, many Cubans rush to the hospital whenever they come
down with a cough or the sniffles, demand expensive tests before they've
even been examined and sometimes get aggressive if doctors refuse.

"Respect for doctors has entirely been lost," he said. "Some will
indulge a patient for fear of how they might react."

The physician spoke on condition of anonymity because he was not
authorized to discuss health care with a foreign journalist. Interview
requests were not granted by the Health Ministry, though a spokeswoman
said in a brief email response that the costs in Granma were the result
of careful study.

The fact that the figures were published at all suggests a sea change in
conceptions about health care, said Nancy Burke, director of the Cuba
Program in Health Diplomacy at the University of California, San Francisco.

"It's interesting that the health care system, which has always been
touted as a basic human right, is now being put into market terms," said
Burke, a medical anthropologist who makes yearly research trips to Cuba.
"That says so much about Raul's market reforms and the ideology ...
informing that. It's a real shift, a major shift in the way of thinking
about health care."

She noted that the island's doctors are increasingly cash cows for Cuba
as it sends them abroad to treat the poor in countries such as
Venezuela. The international missions fulfill a humanitarian purpose but
also offset a significant share of the $28.5 billion in cash and
subsidized oil that the South American nation has sent Cuba since 2005,
according to Venezuelan opposition lawmaker Julio Borges, who says he
uses public records to track the figure.

To cut costs in Cuba, state media have urged doctors to use their
"clinical eye" before ordering pricey lab tests, and target the practice
of people stockpiling medicine to carry them through shortages.

In one TV spot, a woman visits a doctor and requests a long list of
pills. Asked why she needs so many, she replies: "Oh, doctor, it's for
my personal stash."

"I stop cold when I see that, not knowing whether to laugh or cry,"
blogger Greter Torres Vazquez wrote on a Cuban youth-issues website.
"Maybe they've never had the experience of going to the pharmacy and
asking for medicine that their aunt, their grandmother, their mother
needs urgently, only for the worker to say 'Sorry, we ran out five
minutes ago.'"

Some seized on the campaign to complain about corruption in hospitals.

"They should also publish the miserable salary that doctors get paid;
that's an embarrassment," said Maria Soto, a 62-year-old Havana
resident. "And it's serious, because it leads to the problems everyone
knows about: You get bad service or, even worse, they charge you under
the table."

Cuban authorities continuously brag about keeping health care free and
universal despite its lightweight economy and the 50-year-old U.S. embargo.

Experts credit the government's emphasis on prevention and
doctor-patient relationships for life expectancy and infant mortality
rates that are on par with those of wealthy nations. Medical schools
churn out huge graduating classes; every last one of Cuba's 11 million
citizens is supposed to get a house call at least once a year.

Charging for care would be a dramatic and unlikely about-face, but with
15 percent of the budget devoted to health, Havana sees no choice but to
make the system more efficient wherever it can.

After steadily rising over five decades to hit $206 million in 2009,
health spending has dropped, slipping to $190 million last year,
according to government figures. Officials hint at more cuts to come.

These days, authorities rail against "irrational expenses" and have
slashed more than 50,000 less-skilled health-sector jobs, singling out
overstaffed clinics and ambulances with multiple drivers.

Some Cubans say hospital wait times seem to be on the rise and medicine,
equipment and soap are increasingly in short supply.

The clinical doctor consulted by the AP said neither scarcity nor
complaints have worsened, though doctors still suffer heavy case loads
and low pay, about $25 a month.

Cuba is walking a delicate line on health: Too much change could be seen
in some camps as a betrayal of the socialist contract. Too little may
not ease the burden on a strained economy, said Sergio Diaz-Briquets, a
U.S.-based demographer and author of "The Health Revolution in Cuba.

"It is maybe a universal phenomenon that health care systems are
expensive," he said, "but Cuba perhaps cannot afford to have the kind of
services that they claim to have had in the past."


Associated Press writers Andrea Rodriguez and Anne-Marie Garcia
contributed to this report.

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