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Health care system in
Cuba
郭乃文 李翰泓 陳崇崢

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5. 世界衛生組織古巴衛生狀況數據
 男性/女性預期壽命（歲）： 76.2/80.4
 嬰兒死亡率（每千人）： 4.9
 15至60歲男性/女性死亡率（每千人）： 120/78
 每千人擁有醫生（除牙醫）數： 6.8
 每千人擁有牙醫數： 0.87
 每萬人擁有醫院病床數： 49
 人均醫療支出（美元）： 503
 衛生開支占國內生產總值的百分比： 11.8
 愛滋病毒感染百分比： 0.052

6. 你所不知道的古巴
台灣僅存的印象：雪茄、棒球、切˙格瓦拉
★對外醫療
★古巴的醫學教育-拉美醫學院
★社區醫療與家庭醫師
★替代療法

7. 古巴的對外醫療
1. 1963年，古巴援助阿爾及利亞醫療
-古巴公衛部長說，「這很像是乞丐助人，但我們知道，
阿爾及利亞人比我們還更加需要，他們也應該得到這樣
的協助。」
2. 21世紀：
【醫療視為商品】用以診治前來哈瓦那問病的人
俗稱「醫療觀光」，以西方人士為主，以此賺取外匯
【延續了古巴立國以來的國際主義襟懷與實踐】
(a) 為比較貧窮的國家，培訓醫生(拉美醫學院)
(b)海外醫療

8. 拉美醫學院
 為比較貧窮的國家，培訓醫生
 1998年創設
 2007年初，它有一萬名醫科學生（六年制），規模是美國最大
醫科養成機構的十倍
 這所醫學院只招收外國學生，大多數來自拉丁美洲，但也有91位
中低階層的美國人，所有學生就學期間的食宿與學費全免。
 繼續提供海外醫療

9. 古巴的海外醫療
 古巴醫生來到保健相對落後的地區，為其住民提
供醫療服務（比如，至南非協助愛滋病患）
 這項服務也有平時與非常時期兩種。
 【平時】In Venezuela：有1.5萬位醫生與牙醫
 【非常時期】2005/10/25 - 巴基斯坦發生大地震，
古巴有2500位醫療人員持援
 他們與災區的人生活在相同條件，如：住在帳棚，
不是住在飯店
 古巴每萬人平均醫生人數是美國的2.5倍，因此禁
得起長年有三分之一醫生在在海外工作
古巴文化部長：「我們的醫生去幫助他國，使命是醫護，但也承載我們
的價值觀和我們的團結思想」。。

10. Community-Oriented Primary Care
(COPC)
National health institute and hospital center (quaternary care-super specialty)
Provincial hospitals (tertiary care-high specialty)
Municipal hospitals (secondary care-specialty)
Area health centers (primary or community care, 25,000-30,000 people)
policlinicos (specialty clinics, 4000-5000 people)
consultorio.(primary care clinic, 600-700 people)

11. Community-Oriented Primary Care
(COPC)
 Family physicians, paired with nurses
 600 patients or 150 families
 Health promotion and disease prevention
 早上看診，下午居家訪視(急症、慢性病)

12. Medical Records
 All records are organized by families, districts
 Simple, handwritten
 Divide people into groups according to their risk of being
unhealthy
 Smokers: category II
 Stable, chronic lung disease: category III

13. Complementary and Alternative
Medicine (CAM)
 Not necessary to focus on expensive technology as the
initial approach to medical care.
 Students spend 200 hours in the first 2 years of medical school
on CAM
 acupuncture, herbal medicine, trigger point injections ,
massage, heat therapy, transcutaneous electrical nerve
stimulation

14. The Challenge of Cuba’s health care
system?
 Export of domestic medical resources
 Medical equipment, medicine
 Doctors
 Privatization of Medicine
 The rising fee of medical education
 Resource management
 Technology dependence
 Training alignation

15. Export of medicine?
 Due to 50 years trade embargoes from the USA, Cubans
export whatever they can to earn money
 In medical resources, $6 billion/year
 The disparity between domestic and international medical
supply
 Physicians ‘against all odds’

16. Export of MD?
 Education: free
 Obligation to serve in Cuban government
 Sent abroad as the ‘token’ of diplomacy
 Salary: $20 /mo
 USA: $138000 /y
 What would you choose?
 Pressure on domestic MDs

17. Privatization of medicine
 World-acclaimed medical achievements
 Medical tourism
 Doctors frankly sell their service
 Both two best hospitals of Havana: Cira Garcia and CIMEX, run
for benefit
 Big gap between these institutions and public hospitals
 Medical inequity?

18. The rising fee of medical education

19. Huge amount of health care provider?
 High doctor-patient ratio
 How to maintain quality without the dependency of technology?
 Rely on MD’s clinical skill
 Government controlled medical education
 Meet the country’s need
 Increase availability for more equal distribution

20. Conclusion
 What can we learn from Cuba?
 Facilitate community-oriented primary health care
 Free (or cheap) medical education
 Health as an necessity good, health care as a welfare
 Treat our MDs better XD
 Communism XDD

21. Reference
 http://mrzine.monthlyreview.org/2012/fitz071212.html
 http://www.jabfm.org/content/18/4/297.full
 http://cubataiwan.blogspot.tw/2012/10/39552.html
 http://www.nejm.org/doi/full/10.1056/NEJMp1215226
 http://www.economist.com/news/americas/21566670-medicine-
big-business-cuba-nip-and-tuck

22.  http://www.wired.com/wiredscience/2010/04/cuban-health-
lessons/
 http://ije.oxfordjournals.org/content/35/4/817.full
 http://www.ncbi.nlm.nih.gov/pubmed/2315760
 http://www.global-politics.co.uk/issue9/hanna/
 http://www.cubastandard.com/2012/11/02/qa-cubas-health-
system-at-a-crossroads/

23. That’s it!!!