NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

I grew up in the Cold War, so I understand the strong feelings many people have about anything that smacks of socialism – and about the country of Cuba. There are no shortage of reasons to criticize the Cuban government, and communism in general.

And NextBillion is all about free enterprise, which brings innovative solutions to poverty and health care delivery that top-down systems simply can’t match.

But as an admirer of effective health care approaches, I’ve got to say – there’s a lot to like about Cuba’s model.

Consider some of the biggest challenges plaguing health care systems in both the developed and developing worlds:

• High cost: The U.S. spends over $8,000 per person on health care. Cuba spends under $500.
• A shortage of health care workers: while developed countries insource medical personnel from the developing world, Cuba has exported up to 40,000 health workers to around 70 countries, including about 16,000 doctors.
• Provider deficiencies in rural areas: Cuba has at least two government-run medical schools in each of its provinces, and medical students must attend their local school, with the Cuban government encouraging them to practice in their communities.
• Lack of preventive care: In the U.S., over half of patient visits are for primary care, but less than 10 percent of doctors go into primary medicine, preferring more lucrative specialties. In Cuba, practically all medical students study primary care – and afterward, most continue to practice it.

In spite of their wide discrepancy in health spending, Cuba boasts a life-expectancy that matches America’s. Its infant mortality rate is among the lowest in the hemisphere. And it has achieved this in the face of a decades-long U.S. trade embargo, and in spite of the withdrawal of financial support from the former Soviet Union.

Government control of information may require Cuban statistics to be taken with a grain (or a shaker) of salt, and its health care system is far from perfect. State health facilities lack equipment, medicines and infrastructure (due in part to the trade embargo). Cuban physicians are poorly paid relative to other countries, leading to a growing black-market trade in specialty services. And well-connected Cubans have access to superior care – including at the two best hospitals in Havana, which are run for profit. But it’s clear that the public system has managed to do a lot with very little.

What can developing countries learn from Cuba’s model, as they struggle to provide quality care with limited resources? Are there any lessons that could be applied to free market systems that lack Cuba’s centralized control? And how has the Cuban system changed under current president Raul Castro? Dr. Peter Bourne is visiting senior research fellow at Green Templeton College, University of Oxford and chairman of the Board of Medical Education Cooperation with Cuba. He discussed Cuba’s health care system at Unite for Sight’s recent Global Health & Innovation Conference, and sat down for a brief interview. You can view them below. (And click here for some information on Cuba’s tentative steps toward embracing social enterprise.)

An Interview with Peter Bourne

The Cuban Health System Today: Peter Bourne’s Presentation at the 2013 Global Health & Innovation Conference