Cuba does more in health at lower cost

TimesColonist.com – health – Reasons include more doctors, primary care and prevention
January 7, 2012.    By Mark Lemstra, Times Colonist

Despite health-care costs growing at an unsustainable level, disease incidence and prevalence are increasing, even after adjusting for age.

With each passing year, our health-care system is becoming more like the American model.

More investigations, diagnostics and surgeries are performed, with subsequent higher costs and poorer health outcomes.

So let’s compare our health outcomes to a Third World country such as Cuba.

In 2010, the gross national income per capita in Canada was $39,400 while it was $47,200 in the United States and $9,900 in Cuba. To enable apples to apples comparisons, the World Health Organization has standardized purchasing power parity among countries.

Using this formula for 2009, Canada spent $4,196 per capita on health care, the U.S. spent $7,410 while Cuba expended $503.

In other words, after adjusting for purchasing power, Cuba spent about eight times less than Canada, and almost 15 times less than the U.S. on health care.

So what are the results? The WHO reports that the infant mortality rate in 2009 for children under the age of five was six per 1,000 births in Canada, eight in the U.S. and six per 1,000 births in Cuba.

The age standardized annual incidence rate of cancer was 326 per 100,000 population in Canada, 335 in the U.S. and 213 in Cuba. The age standardized annual mortality rate from cancer per 100,000 population was 132, 121 and 145 among the countries respectively.

The prevalence of diabetes was 8.8 per cent in Canada, 8.8 per cent in the U.S. and six per cent in Cuba. The age standardized annual mortality rates per 100,000 population from diabetes were 13, 15 and 14 respectively.

The annual death rates from heart disease per 100,000 population were 129 in Canada, 163 in the U.S and 145 in Cuba.

The International Journal of Epidemiology reports that Cuba was the first country to eliminate polio, the first to eliminate measles. Cuba has eliminated tetanus, diphtheria, pertussis, rubella and mumps, and has the lowest HIV incidence rate in North and South America. It also has one of the lowest infant mortality rates in the world.

So how did Cuba do it? In the 1960s, it began an aggressive public health campaign that included improvements in sanitation and immunization coverage rates. In the 1980s, it reorganized its health system toward primary care, with a goal of having a family doctor in every neighbourhood.

By the 1990s it had 5.9 doctors per 1,000 residents while Canada had only 2.2 per 1,000 residents.

Cuba also refocused the role of doctors by making them responsible for families and entire communities, while it accomplished its goal of having one family doctor per 120 families. Each health clinic includes a nurse to ensure that patients receive the education and counselling needed to change behaviours. As well, most clinics include a social worker to address the non-medical determinants of health.

An article in Social Work indicates that the reasons for success include a health policy that emphasizes prevention over treatment, primary care instead of hospital care, co-ordinated provision of care, providing services in the community where people live, and active participation of residents in goal-setting and programming.

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