cuba's health care system
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Health care system in Cuba郭乃文 李翰泓 陳崇崢
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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
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
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
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
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」。。
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)
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 )
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
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
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
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’
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
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?
The rising fee of medical education
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
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
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
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/
That’s it!!!