Health system in cuba

Designed by Ezeddin oun Soula

Najib mohamed Ibrahim elmasauri

Tareq omar Eljahouni

Istanbul Medipol university

Cuba health system

• Universal

• Free

• Accessible

• Everyone has the right to health protection and care .

• Total population (2015) 11,390,000

• Gross national income per capita (PPP international $, 2011) 18,520

• Life expectancy at birth m/f (years, 2015)77/81

• Probability of dying between 15 and 60 years m/f (per 1 000 population, 2013) 115/73

• Total expenditure on health per capita (Intl $, 2014)2,475

• Total expenditure on health as % of GDP (2014)11.1

• Latest data available from the Global Health Observatory

Stewardship (oversight)

• National (public) health system

• Health care is responsibility of the state.

• Preventive and curative services are integrated.

• The public participates in the health system’s development and functioning.

• Health care activities are integrated with economic and social development.

• Global health cooperation is a fundamental obligation of the health system and its professionals.

Financial resources • Fully integrated system funded by

government as general taxation .

• Very low percentage out of pocket payment OPP.

Resources allocation

• National level

• Provincial level

• Municipal level

Service provision • Family Doctor

• Polyclinics ( consulturio)

• Immunization

• The health system has 22 faculties of medicine, 13 research institutes, 249 hospitals, and 444 polyclinics which respond to the development of medical science, research and teaching, with most of them offering care in specialties and fields of great scientific relevance.

• There are also 143 old-age homes, 289 maternity facilities and provincial and municipal hygiene and epidemiology centres in the 14 provinces and 169 municipalities, which work together on promotional, preventive, curative, and rehabilitative aspects.

Intermediate (instrumental) goals

• Equity:- 99% accessibility in rural and urban .

• Efficiency:- 11.1 % of GDP as total expenditure on health. (WHO 2014 ) .

• Effectiveness: infant mortality rate decreased maternal mortality ratio decreased, life expectancy increased .

Ultimate goals • Responsiveness :- respect to patient at

highest level with indoor service delivery (family physician. Polyclinics.Municipalization of the services as decentralization )

• Fair public financing :- financial risk protected by very minimum OPP ( outpatients medicines, wheelchairs ,hearing aids , crutches .. all state controlled at minimum cost ) .

• Cuba’s health system is strongly focused on prevention .

• Education is a priority, and there is almost universal literacy.

• Health and sexual education are promoted; contraceptives are free.

• Universal health care is free, and everyone has a family physician and nurse.

• the health care system is a nationalized public program.

• The current system was initially created in 1961 by the Cuban Ministry of Public Health, which was charged with the task of developing universal care. In the years since, the system has continued to develop and diversify.

• The system is a relatively smooth combination of public health and medicine.

• '' We sincerely hope that all of the world's inhabitants will have access to quality medical services, as they do in Cuba .”

• Margaret Chan, Director-General of the World Health Organization (WHO), made this statement soon after her visit to Cuba in July 2014.

• The deliberate planning and nationalized system has created a very methodical structure for healthcare in Cuba.

• The levels of administration coincide with the corresponding levels of government – municipal, provincial, and national.

• Each tier finances and directs initiatives based on community needs assessments, constituent interests, and health indicators.

• Medical attention is also split into three common ranks – primary, secondary, and tertiary.

HEALTH SERVICE DELIVERY IN CUBA

Linked health, social

and education sectors — focused on prevention.

One Polyclinic :

30,000—60,000 patient

20-40 family doctors –

nurse office

• Segmentation of assets and labor . The structure of the health system builds upon the base level of primary care,

• with primary care physicians or family doctors distributed within the neighborhoods.

• The next level is the polyclinic, which coordinates the majority of outpatient specialty activity.

• The third level is single specialty tertiary hospital locations, which are distributed in the major cities.

• With over 67 physicians per 100,000 population, Cuba has the best access to physicians.

• The physicians, particularly family doctors, are located in neighborhoods, living within a mile or less of their patient base.

• The physicians know the families, friends, behaviors and risk factors for their neighborhoods.

• The Cuban government controls the supply of healthcare services by organizing the medical training and deployment of physicians and providers across the country and the demand for services through paying for the access to and use of services for the population.

• This model allows an orchestrated balance of supply and demand.

• When there are shortages or surpluses on either side of the supply/demand equation, the government can use its power to affect a more optimal balance.

Health services levels

• The Cuban healthcare system stresses preventive health. Despite limited resources, Cuba has a record unmatched by any economically disadvantaged nation of dealing with chronic and infectious diseases.

• These include polio (eradicated 1962), malaria (eradicated 1967), neonatal tetanus (eradicated 1972), diphtheria (eradicated 1979), congenital rubella syndrome (eradicated 1989), post-mumps meningitis (eradicated 1989), measles (eradicated 1993), rubella (eradicated 1995), and tuberculous meningitis (eradicated 1997).

Health system financing

• the Cuban system is nonprofit and not reimbursement-based,

• there is no need to spend resources on coding and billing claims for services rendered. The office “statistician” focus is on quality indicators

• It concentrated additionally on knowledge and innovation creating

• Creation national biomedical internet grid INFOMED, vaccine production and discovery.

ISSUES IN CUBAN HEALTH SYSTEM

Vertical equity

• research suggests that foreign” health tourists” paying with dollars and senior

communist party officials receive a higher quality of care than Cuban citizen .

• 11.1 % of GPD spent on healthcare for universal coverage with emphasis on prenatal

- infant and hospital care.

Technical Inefficiency

• Deterioration of basic health system infrastructure .

• Scarcity of medicines and other medical input.

Ineffectiveness

excess doctors and extremely low wages .Aging (population-insufficient) facility to deal

with burden . Scarcity of basic resources.

Lack of choice

the state provides the medical care citizens receive .There are no additional providers

and thereforechoice available . .

Medical personnel do not have a choice in where they practice ..

• References :-

• www.who.int

• http://m.ije.oxfordjournals.org/content/35/4/817.long

• http://m.huffpost.com/us/entry/5649968

• http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=25223&Itemid=270&lang=en

• http://www.who.int/alliance-hpsr/alliancehpsr_overview_fr_eng.pdf?ua=1

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464859/

• http://upsidedownworld.org/archives/cuba/why-does-health-care-in-cuba-cost-96-less-than-in-the-us/

• http://files.sld.cu/dne/files/2015/07/anuario-estadistico-de-salud-2014-ingles-e.pdf