Lessons from Cuba: Focus on primary care, public health

Both loved and hated, late Cuban leader Fidel Castro is almost universally praised for one achievement: the creation of a national system that provides free, decent healthcare for his country’s citizens.

With its lower infant mortality rates and life expectancy approaching that of the more industrialized U.S., there are lessons that America can learn from Cuba when it comes to healthcare, agrees Art Caplan, Ph.D., head of the division of medical ethics at the NYU Langone Medical Center, in an interview on WGBH News.

“Their health system over the years has focused on prevention, on public health,” says Caplan. As a result, Cuba has a strong focus on primary care and high vaccination rates, but he says it is still lacking in technology and specialists. “If you had something seriously wrong with you, I don’t think [you] would be rowing to Cuba to do something about it,” he says.

It will be up to history to judge Castro’s legacy following his death last week, but the country’s healthcare system is one of its positives, writes David Blumenthal, M.D., president of The Commonwealth Fund, on a Huffington Post blog. “When it comes to healthcare, Cuba is a success story with few parallels,” says Blumenthal, who visited the small island country in mid-November with a delegation of American healthcare experts.

The base of the healthcare system is almost 13,000 family practices that consist of a physician and a nurse who live in the community they serve, he says. Physicians must visit every patient in their home at least once a year and more often if needed.

The U.S. could duplicate some of those strong outreach programs, says Caplan. The nation can also rely more on nonphysicians, including nurses and physician assistants, to provide better primary care, he says. However, some of Cuba’s tactics to protect public health are tough measures, he said, including quarantining patients with Ebola or Zika and even isolating patients with HIV in camps.

One big difference between the U.S. and Cuba is physician salaries. The radio show hosts pointed out that Cuban doctors are commonly paid $30 to $50 a month. “There’s no $400,000-a-year specialists,” Caplan says.