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Tuesday, May 18, 2010

How Does Cuba Do It?

Cuba has achieved a life expectancy approximately equivalent to the US, despite a long standing embargo on food and medical supplies and despite spending a small fraction of the amount of money per person on health care than we do.

A Stanford social sciences researcher, Paul Drain, has studied Cuba's medical system and has identified a few factors that may be responsible for their success.  Cuba completely subsidizes medical training.  After high school, students who are interested in medical school and qualify for it attend 6 years of combined college and medical training, complete with a stipend for living expenses and then 3 years of postrgraduate training in primary care medicine.  Many do rural health residencies either before or after the postgraduate training. After becoming family practitioners, 35% of them do further specialty training and the rest remain primary care doctors.  There are many multi-specialty clinics which provide care in cities, and small primary care clinics that serve small neighborhoods.  Their vaccination rate is excellent as is their rate of professionally attended births.  Everyone sees a doctor at least once a year and sometimes these are home visits.  Doctors are not paid highly, but then they emerge from training without the usual multi-hundred thousand dollars of educational debt that they end up with in the US.

If one were to look at the economic incentives that have lead to our excessive health care expenses and our shortage of primary care doctors and effective preventive medicine, it is not hard to see how we have landed in our present circumstances.  It is a bit harder to see how we should escape from them.  Certainly subsidizing the training of primary care physicians would be a good start.

Paul Drain was interviewed for Wired, and published an article in the April 30 issue of Science magazine.  This is a link to the Wired article.

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