South Florida Hospital News
Monday August 10, 2020

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May 2015 - Volume 11 - Issue 11

How a New Era in Cuba-U.S. Relations Could Affect Health Care

Ever since news broke back in December about the U.S. opening up relations with Cuba, the health care sectors - in both countries - have taken notice. For decades, the Cuban health care system has been the focus of much international attention and debate.
In fact, Steve Ullmann, a professor at the University of Miami School of Business Administration and director of the Center for Health Sector Management and Policy, recently spotlighted the Cuban health care system in his book, Cuban Health Care: Utopian Dreams, Fragile Future, which he co-authored along with journalist Mary Helen Spooner.
Unlike other discussions that have taken place around the Cuban health care system, Cuban Health Care: Utopian Dreams, Fragile Future does not take a political perspective.
“It really gives a fair perspective on the positives and negatives,” says Ullmann. “Yes, there are some problematic things with Cuba but there are other areas that have great possibilities. There is really a Yin and a Yang to their system.”
The timing of the book’s release was serendipitous since it occurred just three months before the U.S. decision to begin thawing its relations with Cuba.
“The timing was accidental but it probably couldn’t have been better,” Ullmann says. “There is certainly renewed interest of what will happen with the health care relations between the two countries.”
Cuba's system is not a perfect one, with issues of government repression and poverty still casting a looming shadow, yet it stands alone in constructing an advanced health care system with extremely limited resources.
For instance, Cuba has a very significant ratio of medical personnel to population (58.2 per 1,000 people), says Ullmann. “They have one of the highest ratios in the world, even though they are extremely low paid. The average physician in Cuba makes about $28 per month. But they are well trained.”
Since there is a shortage of Spanish-speaking primary care physicians and nurses, the opportunity exists for personnel to move with ease from Cuba to the U.S. Ullmann points out there are currently intensive one-year training programs in the U.S. to train Cuban physicians to become registered nurses. This has drawn much interest among Cuban physicians because U.S. nurses earn an excellent income, many times over what a physician in Cuba makes.
The exchange of ideas between the U.S. and Cuba would be another positive effect, adds Ullmann.
“There is a strongly trained scientific community in Cuba,” he says. “The ability from scientists and physicians from both countries to learn from each other is all positive in terms of exchanging ideas and methodologies for providing care. In addition, places like South Florida, which is located about 90 miles from Cuba, has a relatively well-developed biotech and pharmaceutical sector—sectors that have been well developed in Cuba over the years. There are potential opportunities for some mutually benefit partnerships there as well.”
Since the trade embargo was placed on Cuba, it was quite difficult for Cuban physicians to access pharmaceuticals and medical devices that are taken for granted in other countries. U.S. device makers and pharmaceutical companies could soon have access to a new market hungry for these products.
Although its health care system has been hailed as the Cuban Revolution’s greatest accomplishment—it has a relatively high life expectancy of 78.6 years compared to many other countries—Ullmann and Spooner’s book also calls it a system covered by “such a thick wall of political ideology that critical analysis is difficult.”
Ullmann points out that Cuba’s health care system is based on a two-tiered system and that its theoretical construct is a very strong one. The general population is served by neighborhood-based facilities where care is free, and tourist hospitals which are managed under a state-owned company, Servimed, which caters to paying medical tourists from countries all over the world.
Since Cuba has been performing medical missions in Haiti and other developing countries—such as sending health care workers to fight Ebola in West Africa—the book notes that it generated good will toward the Castro government, “even as humanitarian groups in North America and Europe organize shipments of medicines and medical equipment to Cuban clinics and hospitals plagued by shortages of the most basic supplies.”
Over the years, Cuba’s medical services and public health indicators have improved at some intervals and declined at others due to a fluctuating economy. According to Ullmann and Spooner, Cuban authorities have closed several medical facilities while making other cutbacks in the health budget, even as outbreaks of cholera and dengue fever are occurring in several parts of the country.
“The deterioration of the healthcare infrastructure in Cuba is so significant that the ability to provide care to the local population is very significantly affected,” says Ullmann. “The opening up of relations will hopefully allow for creating better safety through provision of support services for physicians in Cuba.”
As far as what the future holds for Cuba and its health care system, Ullmann says it’s a wait and see approach.
“We have to see how much the relations between the U.S. and Cuba will open and see how open the current Castro regime and whatever follows will be open to importing devices and supplies from the United States,” says Ullmann. “Will they allow the open market to work to a certain extent for the general population?”
Ullmann perceives medical tourism to be one of the areas expanding for Cuba especially with healthcare costs being so high in the U.S. and a country 90 miles away with an ability to provide care in relatively high quality hospitals and lower costs.
“Currently, over 900,000 citizens seek medical care outside of the U.S.,” he says. “This will certainly be a growth factor over time.”
To purchase Cuban Health Care: Utopian Dreams, Fragile Future, visit
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