By Associated Press, The Bismarck Tribune, August 28, 2012
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| Patients wait in a polyclinic |
HAVANA — Cuba’s system of free medical care, long
considered a birthright by its citizens and trumpeted as one of the communist
government’s great successes, is not immune to cutbacks under Raul Castro’s
drive for efficiency.
The health sector has already endured millions of
dollars in budget cuts and tens of thousands of layoffs, and it became clear
this month that Castro is looking for more ways to save when the newspaper
voice of the Communist Party, Granma, published daily details for two weeks on
how much the government spends on everything from anesthetics and acupuncture
to orthodontics and organ transplants.
It’s part of a wider media campaign that seems geared to
discourage frivolous use of medical services, to explain or blunt fears of a
drop-off in care and to remind Cubans to be grateful that health care is still
free despite persistent economic woes. But it’s also raising the eyebrows of
outside analysts, who predict further cuts or significant changes to what has
been a pillar of the socialist system implanted after the 1959 revolution.
“Very often the media has been a leading indicator of
where the economic reforms are going,” said Phil Peters, a longtime Cuba
observer at the Lexington Institute think tank. “My guess is that there’s some
kind of policy statement to follow, because that’s been the pattern.”
The theme of the Granma pieces, posters in clinics and
ads on state TV is the same: “Your health care is free, but how much does it
cost?”
The answer is, not much by outside standards, but quite
a bit for Cuba, which spends $190 million a year paying for its citizens’
medical bills.
Based on the official exchange rate, the government
spends $2 each time a Cuban visits a family doctor, $4.14 for each X-ray and
$6,827 for a heart transplant.
It’s not a luxury service, though. Scarcities now are
common and sanitary conditions fall short of the ideal in decaying facilities
where paint peels from the walls. Patients often bring their own bed sheets,
electric fans, food and water for hospital stays.
One Havana-based clinical physician applauded the
campaign, saying it targets a pervasive problem: Conditioned to think about
health as an inalienable right, many Cubans rush to the hospital whenever they
come down with a cough or the sniffles, demand expensive tests before they’ve
even been examined and sometimes get aggressive if doctors refuse.
“Respect for doctors has entirely been lost,” he said. “Some
will indulge a patient for fear of how they might react.”
The physician spoke on condition of anonymity because he
was not authorized to discuss health care with a foreign journalist. Interview
requests were not granted by the Health Ministry, though a spokeswoman said in
a brief email response that the costs in Granma were the result of careful study.
The fact that the figures were published at all suggests
a sea change in conceptions about health care, said Nancy Burke, director of
the Cuba Program in Health Diplomacy at the University of California, San
Francisco.
“It’s interesting that the health care system, which has
always been touted as a basic human right, is now being put into market terms,”
said Burke, a medical anthropologist who makes yearly research trips to Cuba. “That
says so much about Raul’s market reforms and the ideology ... informing that.
It’s a real shift, a major shift in the way of thinking about health care.”
She noted that the island’s doctors are increasingly
cash cows for Cuba as it sends them abroad to treat the poor in countries such
as Venezuela. The international missions fulfill a humanitarian purpose but
also offset a significant share of the
$28.5 billion in cash and subsidized oil that the South
American nation has sent Cuba since 2005, according to Venezuelan opposition
lawmaker Julio Borges, who said he uses public records to track the figure.
To cut costs in Cuba, state media have urged doctors to
use their “clinical eye” before ordering pricey lab tests, and target the
practice of people stockpiling medicine to carry them through shortages.
In one TV spot, a woman visits a doctor and requests a
long list of pills. Asked why she needs so many, she replies: “Oh, doctor, it’s
for my personal stash.”
“I stop cold when I see that, not knowing whether to
laugh or cry,” blogger Greter Torres Vazquez wrote on a Cuban youth-issues
website. “Maybe they’ve never had the experience of going to the pharmacy and
asking for medicine that their aunt, their grandmother, their mother needs
urgently, only for the worker to say ‘Sorry, we ran out five minutes ago.’”
Some seized on the campaign to complain about corruption
in hospitals.
“They should also publish the miserable salary that doctors get
paid; that’s an embarrassment,” said Maria Soto, a 62-year-old Havana resident.
“And it’s serious, because it leads to the problems everyone knows about: You
get bad service or, even worse, they charge you under the table.”
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