Cuba squeezed by health care costs
Cuba's health sector has had millions of dollars in budget cuts and tens
of thousands of layoffs.
The 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 outside analysts
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
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 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 cash cows for Cuba as it sends
them abroad to 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.
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
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
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.