The main reason is that the Cuban government spends money primarily on its own elite and foreign health patients, he says.
Salazar-Carrillo estimates Cuba receives $300-400 million a year in humanitarian aid from the United States in the form of medicines and medical devices. Despite that, there is a serious shortage for the Cuban population, he says. “Medicine [is] very unavailable in Cuba, especially the most simple medicines which to take care of every day problems, like aspirin, band-aids and syringes,” he says. “The doctors are always having to prescribe alternative medicine because the ones they would like is not available.”
Pérez-Stable believes the U.S. embargo does play a factor in the lack of medicines. “The pharmaceutical industry is global and many products are not sold to Cuba either because of the economic embargo or because Cuba will not pay the high prices,” he says.
To compensate, the Cubans have tried to develop their own home industry as well as promote the generics and non-patent use industry prevalent in Brazil and India, Pérez-Stable says. And management of many chronic diseases with new drugs has expanded tremendously in the last 20 years, he adds. “Cuba has not kept up because of the economic limitations,” he says. “The absence of a market also complicates the issue by shutting out any options.”
CUBA BETTER THAN USA?
So, is Cuba’s healthcare system better than the United States, as is implied in Sicko? “Are you kidding?” says Salazar-Carrillo. “The U.S. is considered the best healthcare system in the world and Cuba ranks among the lowest or worst.” Suchlicki concurs. The Cuban system is not better, but it’s free, he says.
“Although there is universal access to care in Cuba and some selected aspects of the health care system may at times compare favorably with the U.S., I don’t believe anyone would say with any degree of believability that it is “better” than the US,” says Pérez-Stable. “This would especially apply in the persons with chronic diseases such as diabetes, heart failure or any form of cancer. “
The Cuban health care system may be very “cost efficient” in that the favorable outcomes are obtained at a relatively modest investment, while the U.S. system is known for being the most expensive, yet having inferior outcomes to many developed European countries and Japan, he says.
However, there are areas where Cuba has not done as well as one may have expected, Pérez-Stable argues. “Cervical cancer rates remain two to three times that in the U.S. when access to Pap smears and treatment should have led to similarly low rates,” he says. “Cuba is also experiencing the biggest lung cancer epidemic in the Americas outside the U.S. and Canada and this may have been preventable 20 years ago with a concerted effort to control tobacco smoking.”
