The document provides an overview of the current state and future projections of Cuba's healthcare system. It finds that while Cuba currently provides universal healthcare, the system is under strain due to an aging population increasing demand. Key challenges include inadequate infrastructure and medical equipment as well as physician brain drain. Projecting 20 years into the future, the report expects little change and continued challenges, with the system largely preserving its current model through stagnant funding and policies. Several alternative scenarios are possible depending on uncertainties around political and economic changes.
Summary of Telemedicine study in Serbia / Sažetak studije o Telemedicini u Sr...NALED Serbia
Studija o potencijalima primene telemedicine u Srbiji i njenim benefitima za građane i lokalne samouprave.
Study on the potentials of implementation of telemedicine in Serbia and its benefits for the citizens and local governments.
This document provides a public expenditure review of the Kenyan Ministry of Health for 2007. It outlines the overall and specific objectives of the review, which include presenting government health policies and programs, examining public health expenditure distributions, and assessing budget effectiveness and constraints. Key findings are that communicable diseases remain prevalent, but fertility and population growth rates are declining. The multi-tiered health system has issues with capacity, financing, accessibility, and centralized allocation of funds. The National Health Sector Strategic Plan is aligned with the country's Economic Recovery Strategy to improve financing, target the poor, increase cross-sector cooperation and efficiency, and boost government health funding.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
The document discusses alternative sustainable financing options for primary health care services in Kenya. It notes that while the Kenyan government is committed to providing quality primary health care, budgetary allocations to health care have declined and out-of-pocket spending is high. User fees intended to increase cost recovery have negatively impacted access to care. The study examines alternative financing mechanisms that could help mitigate these trends, such as pooling funds to protect the poor from catastrophic costs, establishing taxes specifically for health care, and issuing bonds for health infrastructure. However, identifying the poor and providing safety nets like waivers will be important for the success of any new mechanisms.
Kano State has a population of over 9 million people, most of whom live rurally. The state has high rates of HIV, tuberculosis, maternal mortality, and child mortality. USAID/HFG has worked in Kano State to establish a Technical Working Group on tuberculosis funding and advocate for the inclusion of TB services in the state's contributory health insurance scheme. Key accomplishments include establishing a functional TWG, conducting an analysis of TB burden and funding gaps, and building stakeholder capacity in health financing. Challenges include untimely release of funds and limitations of the project's duration. Continued advocacy and establishing follow-on support are recommended.
Capacity building of private sector workforce for publicDrChetanSharma5
The document discusses capacity building of India's private sector healthcare workforce to provide public health services. It notes that while the public sector was initially the main healthcare provider, the private sector now accounts for over 70% of healthcare services. However, private sector services are often more expensive and unregulated. The document proposes strategies like competency training, incentives, and integrating informal providers to help mobilize the private sector workforce to improve access and quality of public health services while addressing challenges of regulation and costs.
This document provides an overview of key concepts in health financing for universal health coverage. It discusses UHC goals and objectives, important contextual factors that influence health policy, methods for analyzing health expenditures, reviewing financing arrangements, and assessing progress toward UHC. The document outlines a framework for conducting an integrated assessment of a country's health system to identify challenges and priorities for reform in order to make progress on achieving universal access to needed health services of sufficient quality.
A view on canada healthcare sector and go to market strategy formulationSuman Mishra
An overview on
- Canada Healthcare Market , how it compares with other common wealth countries and US
- Deep Dives into Canada Government Healthcare Market
- The Value chain of Canada Healthcare Market
- The market size and key players
- The trends observed in the market
- Some Key Recommendations while formulating the "Go to Market"
Fellows Rural Health Care Policy Report FinalSadullah Karimi
The document proposes refunding and restructuring Virginia's Physician Loan Repayment Program to address the lack of primary care physicians in rural areas of the state. It cites factors contributing to physician shortages in rural areas like geography, uninsured patients, an aging physician population, and medical school debt. The program previously helped recruit physicians to underserved areas but lost funding in 2010. The proposal recommends restarting the program with $750,000 in funding to incentivize physicians to practice primary care in rural Virginia through loan repayment, which could help improve access to healthcare with minimal costs.
Summary of Telemedicine study in Serbia / Sažetak studije o Telemedicini u Sr...NALED Serbia
Studija o potencijalima primene telemedicine u Srbiji i njenim benefitima za građane i lokalne samouprave.
Study on the potentials of implementation of telemedicine in Serbia and its benefits for the citizens and local governments.
This document provides a public expenditure review of the Kenyan Ministry of Health for 2007. It outlines the overall and specific objectives of the review, which include presenting government health policies and programs, examining public health expenditure distributions, and assessing budget effectiveness and constraints. Key findings are that communicable diseases remain prevalent, but fertility and population growth rates are declining. The multi-tiered health system has issues with capacity, financing, accessibility, and centralized allocation of funds. The National Health Sector Strategic Plan is aligned with the country's Economic Recovery Strategy to improve financing, target the poor, increase cross-sector cooperation and efficiency, and boost government health funding.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
The document discusses alternative sustainable financing options for primary health care services in Kenya. It notes that while the Kenyan government is committed to providing quality primary health care, budgetary allocations to health care have declined and out-of-pocket spending is high. User fees intended to increase cost recovery have negatively impacted access to care. The study examines alternative financing mechanisms that could help mitigate these trends, such as pooling funds to protect the poor from catastrophic costs, establishing taxes specifically for health care, and issuing bonds for health infrastructure. However, identifying the poor and providing safety nets like waivers will be important for the success of any new mechanisms.
Kano State has a population of over 9 million people, most of whom live rurally. The state has high rates of HIV, tuberculosis, maternal mortality, and child mortality. USAID/HFG has worked in Kano State to establish a Technical Working Group on tuberculosis funding and advocate for the inclusion of TB services in the state's contributory health insurance scheme. Key accomplishments include establishing a functional TWG, conducting an analysis of TB burden and funding gaps, and building stakeholder capacity in health financing. Challenges include untimely release of funds and limitations of the project's duration. Continued advocacy and establishing follow-on support are recommended.
Capacity building of private sector workforce for publicDrChetanSharma5
The document discusses capacity building of India's private sector healthcare workforce to provide public health services. It notes that while the public sector was initially the main healthcare provider, the private sector now accounts for over 70% of healthcare services. However, private sector services are often more expensive and unregulated. The document proposes strategies like competency training, incentives, and integrating informal providers to help mobilize the private sector workforce to improve access and quality of public health services while addressing challenges of regulation and costs.
This document provides an overview of key concepts in health financing for universal health coverage. It discusses UHC goals and objectives, important contextual factors that influence health policy, methods for analyzing health expenditures, reviewing financing arrangements, and assessing progress toward UHC. The document outlines a framework for conducting an integrated assessment of a country's health system to identify challenges and priorities for reform in order to make progress on achieving universal access to needed health services of sufficient quality.
A view on canada healthcare sector and go to market strategy formulationSuman Mishra
An overview on
- Canada Healthcare Market , how it compares with other common wealth countries and US
- Deep Dives into Canada Government Healthcare Market
- The Value chain of Canada Healthcare Market
- The market size and key players
- The trends observed in the market
- Some Key Recommendations while formulating the "Go to Market"
Fellows Rural Health Care Policy Report FinalSadullah Karimi
The document proposes refunding and restructuring Virginia's Physician Loan Repayment Program to address the lack of primary care physicians in rural areas of the state. It cites factors contributing to physician shortages in rural areas like geography, uninsured patients, an aging physician population, and medical school debt. The program previously helped recruit physicians to underserved areas but lost funding in 2010. The proposal recommends restarting the program with $750,000 in funding to incentivize physicians to practice primary care in rural Virginia through loan repayment, which could help improve access to healthcare with minimal costs.
The Russian healthcare system faces significant challenges including poor organization, lack of government funding, outdated equipment, and low pay for healthcare workers. As a result, many Russian citizens struggle to access acceptable healthcare. While Russia spends less on healthcare as a percentage of GDP compared to other countries, there have been some improvements in recent decades like increased spending, salary growth, and national priority programs. However, barriers like inequality between urban and rural areas, high alcoholism rates, and neglect of stigmatized groups continue to negatively impact health outcomes in Russia.
The document discusses the history and current state of Teaching Health Centers (THCs), which provide primary care medical residency training in community and rural health centers. Key points:
- THCs were established in 2010 under the ACA to expand GME outside of hospitals. There are now 44 THC programs across 21 states.
- THCs receive funding through 2015 from HRSA, but this funding will expire without reauthorization. Current residents may not complete training if funding lapses.
- Legislation has been introduced to extend THC funding for 5 more years, but long-term support is still uncertain. The program shows promise for training more primary care physicians for underserved areas.
The United States spends the highest amount on health care per capita compared to other countries. Health care represents almost one-fifth of the U.S. economy and health care jobs are one of the fastest growing sectors. National health care spending can be examined based on categories of service, sources of funding, and types of insurance payers. In 2013, the U.S. spent over $3 trillion on health care, with hospital care, physician/clinical services, and prescription drugs representing the largest categories of spending. Employers and households are the primary contributors to national health expenditures.
Botswana Health Accounts 2013-14: Key Findings and ImplicationsHFG Project
The Botswana 2013/14 HA exercise was conducted between July 2015 and September 2016. The study covers the 2013/14 fiscal year (1 April 2013–31 March 2014). In mid-2015, the HA team, with representation from the Government of Botswana, the Health Finance and Governance (HFG) project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data were imported into the HA Production Tool (HAPT) and mapped to each of the System of Health Accounts (SHA) 2011 classifications. The results of the analysis were verified with the Health Financing Technical Working Group on 9 October 2016 and the Ministry of Health and Wellness (MoHW) management on 10 October 10 2016. Participants involved in the production and validation of the results, and recommended for future HA workshops, are listed in Annex A.
During the webinar, attendees will be presented with:
- An overview of the basic roles and responsibilities of federal and provincial governments within our healthcare system
- A review of the key players and structures operating within the system
- The differences between engaging politicians and bureaucrats when advocating within the healthcare system. Each has important and different roles to play.
This webinar reviewed the bills, resolution, and budgetary items discussed during the 2016 Legislative Session that may impact Georgia’s health care system and health care consumers. The slides can be dowloaded below, or the archived webinar can be accessed via the HealthTec distance learning site at http://www.healthtecdl.org/events/details/Changes-in-Health-Care-and-Policy-in-the-2016-Georgia-Legislative-Session.cfm.
This document profiles the health landscape of Bauchi State, Nigeria. It provides statistics on the population, health indices, stakeholders, and challenges in the state's health sector. It also summarizes the work and achievements of the USAID/HFG project in Bauchi State, which helped establish governance structures like a health financing unit and insurance scheme. Through evidence generation and multi-sectoral collaboration, the project supported increased funding allocations and releases for health. However, fully utilizing human resources and sustaining gains remain ongoing challenges.
The Russian healthcare system suffers from a lack of integration between providers, overreliance on inpatient care compared to other countries, and underfunding that has led to shortages and outdated infrastructure. Primary care is understaffed while hospitals have high admission and length of stay rates. Many hospitals and clinics lack basic sanitation facilities like running water and sewage. Dental care is generally private and too expensive for most citizens.
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
National health accounts - Ali Nurgozhayev, KazakhstanOECD Governance
This presentation was made by Ali Nurgozhayev, Kazakhstan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
The Boston Public Health Commission aims to help residents meet basic needs like nutritious food. However, federal programs like SNAP have strict income limits that exclude the "threshold population" - those who earn too much to qualify but still struggle with food insecurity due to high living costs. This report develops a Composite Index using multiple food insecurity databases to identify and track the threshold population in Boston. Stakeholder interviews found root causes include housing costs and a need for targeted solutions. The index criteria could help the Commission direct resources to this vulnerable group.
Basic patterns in national health expenditureRameez Rameez
This document summarizes research on national health expenditures. It finds that total health spending as a percentage of GDP rises with country income from 2-9%. Some countries spend less than needed to provide basic services. Most health spending is publicly financed through taxes, social health insurance, or private insurance. Out-of-pocket spending decreases as income rises. The author concludes that in poor countries, total health spending is too low and out-of-pocket costs are catastrophic for some households, so public subsidies are needed to expand insurance coverage to the poor.
Dr. Sudhakar Shinde at India Leadership Conclave 2019Indian Affairs
National Health Protection Scheme - Challenges of ensuring Quality Healthcare at Affordable Costs.
Dr. Sudhakar Shinde, CEO, Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY)
Adding complexity to an already difficult task: Monitoring the impact of the ...soder145
The document summarizes research comparing estimates of Medicaid enrollment in 2013 and 2014 from the American Community Survey (ACS) and Centers for Medicare and Medicaid Services (CMS) administrative data. The research finds that states with the largest increases in Medicaid enrollment according to CMS also tended to have the largest differences between ACS and CMS estimates, with ACS generally reporting lower enrollment. This suggests the ACS may overstate uninsurance rates where Medicaid enrollment increased substantially. However, misreported coverage likely represents shifts between coverage types rather than uninsurance. Future research should analyze additional years of data and link administrative and survey sources to better understand reporting errors.
The document discusses key aspects of Canada's universal healthcare system. It notes that Canadians access healthcare by obtaining a provincial health card, which allows them to visit physicians and healthcare providers without deductibles. The system is funded through taxes at both the federal and provincial levels. While Canadians generally have access to doctors and report satisfaction with the care received, some do experience waits for primary care appointments or in emergency departments. The Canadian system differs from that of the U.S. in its public funding and universal coverage of all residents.
Policy framework for health care financing reform in NigeriaHFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
The document analyzes the alignment between Rwanda's Essential Package of Health Services (EPHS) and its major health benefit plans (HBPs), including Community-Based Health Insurance (CBHI) schemes. There is limited alignment between the EPHS and CBHI HBP, as the HBP lacks specificity and many EPHS services fall under broader HBP categories. Maternal health services are mentioned broadly in the HBP, while newborn health and child health are not well represented. Some services, like occupational diseases and accidents, are excluded from the HBP but included in the EPHS. Overall, 11% of services align fully, 2% partially align, 4% align broadly, and 79%
Presentation by Chad Shirley, Deputy Assistant Director for Microeconomic Studies, at the National Association for Business Economics Annual Meeting panel discussion on prioritizing infrastructure investment.
The changing demographics of the uninsured in MN and the nationsoder145
The document analyzes changes in the demographics of the uninsured in Minnesota and nationally between 2013 and 2014 following coverage expansions under the Affordable Care Act. It finds that uninsured rates declined significantly in both Minnesota and all 50 states. While the characteristics of the uninsured remained largely the same, the uninsured population is now more likely to be Hispanic, non-citizens, and Spanish speakers in both Minnesota and nationally. The uninsured are also less likely to be children in Minnesota and very low income or Asian nationally. Continued outreach efforts are needed to enroll groups with historically high uninsurance rates.
The document summarizes the healthcare system and market in Saudi Arabia. It notes that Saudi Arabia has the largest healthcare market in the GCC, with advanced infrastructure and facilities. The country is expected to see increased healthcare needs due to population growth, aging, and conditions exacerbated by wealth like obesity and diabetes. The healthcare market is growing, with the inpatient and outpatient markets projected to reach $3.6 billion and $22 billion respectively by 2015. The system is highly competitive with many public and private providers.
Cuba has made major accomplishments in healthcare since 1959, including a rise in life expectancy and declines in infant mortality. Healthcare is accessible to all Cubans and focuses on preventative care and primary care. However, shortages of medications and medical equipment due to US trade embargoes have posed challenges. Cuba relies heavily on tourism and exporting healthcare professionals to other countries to generate needed foreign currency.
it is short overview of health system in cuba .where it is considered as efficient public health system in the world with lowest levels of mortality and morbidity .
The Russian healthcare system faces significant challenges including poor organization, lack of government funding, outdated equipment, and low pay for healthcare workers. As a result, many Russian citizens struggle to access acceptable healthcare. While Russia spends less on healthcare as a percentage of GDP compared to other countries, there have been some improvements in recent decades like increased spending, salary growth, and national priority programs. However, barriers like inequality between urban and rural areas, high alcoholism rates, and neglect of stigmatized groups continue to negatively impact health outcomes in Russia.
The document discusses the history and current state of Teaching Health Centers (THCs), which provide primary care medical residency training in community and rural health centers. Key points:
- THCs were established in 2010 under the ACA to expand GME outside of hospitals. There are now 44 THC programs across 21 states.
- THCs receive funding through 2015 from HRSA, but this funding will expire without reauthorization. Current residents may not complete training if funding lapses.
- Legislation has been introduced to extend THC funding for 5 more years, but long-term support is still uncertain. The program shows promise for training more primary care physicians for underserved areas.
The United States spends the highest amount on health care per capita compared to other countries. Health care represents almost one-fifth of the U.S. economy and health care jobs are one of the fastest growing sectors. National health care spending can be examined based on categories of service, sources of funding, and types of insurance payers. In 2013, the U.S. spent over $3 trillion on health care, with hospital care, physician/clinical services, and prescription drugs representing the largest categories of spending. Employers and households are the primary contributors to national health expenditures.
Botswana Health Accounts 2013-14: Key Findings and ImplicationsHFG Project
The Botswana 2013/14 HA exercise was conducted between July 2015 and September 2016. The study covers the 2013/14 fiscal year (1 April 2013–31 March 2014). In mid-2015, the HA team, with representation from the Government of Botswana, the Health Finance and Governance (HFG) project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data were imported into the HA Production Tool (HAPT) and mapped to each of the System of Health Accounts (SHA) 2011 classifications. The results of the analysis were verified with the Health Financing Technical Working Group on 9 October 2016 and the Ministry of Health and Wellness (MoHW) management on 10 October 10 2016. Participants involved in the production and validation of the results, and recommended for future HA workshops, are listed in Annex A.
During the webinar, attendees will be presented with:
- An overview of the basic roles and responsibilities of federal and provincial governments within our healthcare system
- A review of the key players and structures operating within the system
- The differences between engaging politicians and bureaucrats when advocating within the healthcare system. Each has important and different roles to play.
This webinar reviewed the bills, resolution, and budgetary items discussed during the 2016 Legislative Session that may impact Georgia’s health care system and health care consumers. The slides can be dowloaded below, or the archived webinar can be accessed via the HealthTec distance learning site at http://www.healthtecdl.org/events/details/Changes-in-Health-Care-and-Policy-in-the-2016-Georgia-Legislative-Session.cfm.
This document profiles the health landscape of Bauchi State, Nigeria. It provides statistics on the population, health indices, stakeholders, and challenges in the state's health sector. It also summarizes the work and achievements of the USAID/HFG project in Bauchi State, which helped establish governance structures like a health financing unit and insurance scheme. Through evidence generation and multi-sectoral collaboration, the project supported increased funding allocations and releases for health. However, fully utilizing human resources and sustaining gains remain ongoing challenges.
The Russian healthcare system suffers from a lack of integration between providers, overreliance on inpatient care compared to other countries, and underfunding that has led to shortages and outdated infrastructure. Primary care is understaffed while hospitals have high admission and length of stay rates. Many hospitals and clinics lack basic sanitation facilities like running water and sewage. Dental care is generally private and too expensive for most citizens.
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
National health accounts - Ali Nurgozhayev, KazakhstanOECD Governance
This presentation was made by Ali Nurgozhayev, Kazakhstan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
The Boston Public Health Commission aims to help residents meet basic needs like nutritious food. However, federal programs like SNAP have strict income limits that exclude the "threshold population" - those who earn too much to qualify but still struggle with food insecurity due to high living costs. This report develops a Composite Index using multiple food insecurity databases to identify and track the threshold population in Boston. Stakeholder interviews found root causes include housing costs and a need for targeted solutions. The index criteria could help the Commission direct resources to this vulnerable group.
Basic patterns in national health expenditureRameez Rameez
This document summarizes research on national health expenditures. It finds that total health spending as a percentage of GDP rises with country income from 2-9%. Some countries spend less than needed to provide basic services. Most health spending is publicly financed through taxes, social health insurance, or private insurance. Out-of-pocket spending decreases as income rises. The author concludes that in poor countries, total health spending is too low and out-of-pocket costs are catastrophic for some households, so public subsidies are needed to expand insurance coverage to the poor.
Dr. Sudhakar Shinde at India Leadership Conclave 2019Indian Affairs
National Health Protection Scheme - Challenges of ensuring Quality Healthcare at Affordable Costs.
Dr. Sudhakar Shinde, CEO, Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY)
Adding complexity to an already difficult task: Monitoring the impact of the ...soder145
The document summarizes research comparing estimates of Medicaid enrollment in 2013 and 2014 from the American Community Survey (ACS) and Centers for Medicare and Medicaid Services (CMS) administrative data. The research finds that states with the largest increases in Medicaid enrollment according to CMS also tended to have the largest differences between ACS and CMS estimates, with ACS generally reporting lower enrollment. This suggests the ACS may overstate uninsurance rates where Medicaid enrollment increased substantially. However, misreported coverage likely represents shifts between coverage types rather than uninsurance. Future research should analyze additional years of data and link administrative and survey sources to better understand reporting errors.
The document discusses key aspects of Canada's universal healthcare system. It notes that Canadians access healthcare by obtaining a provincial health card, which allows them to visit physicians and healthcare providers without deductibles. The system is funded through taxes at both the federal and provincial levels. While Canadians generally have access to doctors and report satisfaction with the care received, some do experience waits for primary care appointments or in emergency departments. The Canadian system differs from that of the U.S. in its public funding and universal coverage of all residents.
Policy framework for health care financing reform in NigeriaHFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
The document analyzes the alignment between Rwanda's Essential Package of Health Services (EPHS) and its major health benefit plans (HBPs), including Community-Based Health Insurance (CBHI) schemes. There is limited alignment between the EPHS and CBHI HBP, as the HBP lacks specificity and many EPHS services fall under broader HBP categories. Maternal health services are mentioned broadly in the HBP, while newborn health and child health are not well represented. Some services, like occupational diseases and accidents, are excluded from the HBP but included in the EPHS. Overall, 11% of services align fully, 2% partially align, 4% align broadly, and 79%
Presentation by Chad Shirley, Deputy Assistant Director for Microeconomic Studies, at the National Association for Business Economics Annual Meeting panel discussion on prioritizing infrastructure investment.
The changing demographics of the uninsured in MN and the nationsoder145
The document analyzes changes in the demographics of the uninsured in Minnesota and nationally between 2013 and 2014 following coverage expansions under the Affordable Care Act. It finds that uninsured rates declined significantly in both Minnesota and all 50 states. While the characteristics of the uninsured remained largely the same, the uninsured population is now more likely to be Hispanic, non-citizens, and Spanish speakers in both Minnesota and nationally. The uninsured are also less likely to be children in Minnesota and very low income or Asian nationally. Continued outreach efforts are needed to enroll groups with historically high uninsurance rates.
The document summarizes the healthcare system and market in Saudi Arabia. It notes that Saudi Arabia has the largest healthcare market in the GCC, with advanced infrastructure and facilities. The country is expected to see increased healthcare needs due to population growth, aging, and conditions exacerbated by wealth like obesity and diabetes. The healthcare market is growing, with the inpatient and outpatient markets projected to reach $3.6 billion and $22 billion respectively by 2015. The system is highly competitive with many public and private providers.
Cuba has made major accomplishments in healthcare since 1959, including a rise in life expectancy and declines in infant mortality. Healthcare is accessible to all Cubans and focuses on preventative care and primary care. However, shortages of medications and medical equipment due to US trade embargoes have posed challenges. Cuba relies heavily on tourism and exporting healthcare professionals to other countries to generate needed foreign currency.
it is short overview of health system in cuba .where it is considered as efficient public health system in the world with lowest levels of mortality and morbidity .
Cuba is an island nation in the Caribbean Sea whose capital and largest city is Havana. The population of Cuba is approximately 11.5 million people, most of whom are Roman Catholic. The economy is largely state-controlled and centered around exports like sugar, tobacco, and coffee. Cuba has a long history dating back to indigenous peoples and Spanish colonization. It gained independence in the late 19th century but has had a tumultuous relationship with the United States, leading to the Cuban Revolution in the 1950s and establishment of a communist government under Fidel Castro.
El documento describe los sistemas de salud de México y Cuba. México tiene un sector público que incluye al IMSS, ISSSTE, PEMEX y Secretarías de Salud, y un sector privado. Cuba solo tiene un sector público financiado por el gobierno que provee cobertura universal. Ambos países enfrentan transiciones epidemiológicas con enfermedades crónicas siendo las principales causas de muerte.
Estudio comparativo de los sistemas de salud en el mundoJenny Guevara M
Israel tiene un sistema de salud de alta calidad que proporciona cobertura universal a todos los ciudadanos a través de cuatro cajas médicas financiadas por el gobierno. El sistema se basa en el diagnóstico temprano para prevenir complicaciones costosas y se reconoce internacionalmente por sus contribuciones a la medicina. Sin embargo, también se critica por las largas esperas y los altos impuestos.
El sistema de salud de Canadá es financiado por el estado a través de impuestos y cotizaciones obligatorias. Los hospitales y médicos son pagados con presupuestos anuales negociados, y los pacientes pueden elegir libremente sus proveedores de atención. Aunque la atención médicamente necesaria es gratuita, la mayoría de medicamentos requieren pago parcial o total. El sistema canadiense busca proporcionar atención igual para todos, pero recientemente ha habido llamados para mejorar el servicio debido a largas esperas
This document discusses the history of the healthcare system in the US and the changing role of physicians within that system. It notes that physicians originally had close personal relationships with patients but that hospitals and specialization led to more fragmented care. Government programs like Medicare and the rise of managed care further changed the physician role by increasing administrative duties. The document examines the current medical school curriculum, noting a lack of leadership and management training. It discusses some programs that do offer such training but notes they are electives, not mandatory. The document concludes there are gaps in preparing physicians for the changing healthcare system and future skills needed in areas like business, communication, and leadership.
Term Paper_BIG DATA AND ONTARIOS PRIMARY CARE SECTOR (00000003)Emmanuel Casalino
This document discusses the potential role of big data in primary care in Ontario. It outlines how big data could help support clinical decision making, enhance practice workflow, and improve continuity of care from the patient's perspective. Specifically, big data could help with preventative care, quality of care, patient co-management, decision support, and population health management. Currently, primary care relies heavily on paper records and data is fragmented across different systems. The province has invested in electronic health records but more can be done to leverage big data to transform primary care.
PPACA aims to expand health insurance coverage to over 95% of New Mexicans through Medicaid expansion and subsidies. It provides funding to expand community health centers, public health programs, and the healthcare workforce. The law also establishes regulations to increase access to care, reduce costs, and improve quality of care. It is projected to save over $1 trillion in health spending by 2029 while extending the solvency of Medicare. Counties are encouraged to maintain health councils to help coordinate services and apply for new grant opportunities under PPACA.
The document discusses the rising prevalence of non-communicable diseases (NCDs) like obesity, diabetes, heart disease and cancer in GCC countries due to rapid lifestyle changes following increased oil wealth. It notes high rates of obesity, reaching over 75% of adults in some countries, and diabetes affecting around 1 in 5 adults in Saudi Arabia and Kuwait. This shift is attributed to diets high in sugar and processed foods replacing traditional diets, along with more sedentary lifestyles. The report argues early diagnosis and preventative healthcare are needed to curb NCDs and help GCC countries achieve their economic goals.
Using the case study below, develop a written report of your market .pdfmanjan6
Using the case study below, develop a written report of your market analysis. Include a visual
diagram of your overall market analysis use of strategic thinking maps (see diagram in the
Module) as a tool to assist with the different facets of the strategic planning process.
The map is to be used as a supplement for your written market analysis. The market analysis
produced will be used in the final submission of your Capstone Project.
Your well-written market analysis should meet the following requirements:
Be 3-4 pages in length, not including the cover, abstract (optional), or reference pages.
Utilize headings to organize the content.
Include the strategic thinking map in addition to/or as a part of the 3-4 pages of content.
Include a minimum of four references with associated in-text citations.
The circumstances in Pocahontas County resonate in many rural communities across the country:
• A depressed local economy
• Substantial barriers to health access
• Difficulty in attracting health professionals.
Portrait of Pocahontas County
Pocahontas County is located in the southeast region of West Virginia. The county has a total of
942 square miles and is the site of the head waters for eight rivers: Cherry River, Cranberry
River, Elk River, Ganley River, Greenbriar River, Tygart Valley River, Williams River, and
Shaver Fork of the Cheat River. Pocahontas County consists of the following towns: Arborale,
Bartow, Buckeye, Cass, Dunmore, Durbin, Greenbank, Hillsboro, Marlington, and Slatyfork.
As of the 2010 Census there are 9,131 people residing in Pocahontas County. The racial makeup
is 98% Caucasian, .78% African American, .43% Hispanic, .14% Asian, and .07% Native
American. The median income for a household within the county is $26,401.
Access to Health Services
Pocahontas County has a shortage of healthcare providers. There is one hospital, Pocahontas
Memorial Hospital, and one nursing home, Pocahontas Center. The ratio for dentists is 8,851 to
1. The ratio for primary care physicians is 8508 to 1 (County Health Roadmaps & Rankings,
n.d.). The county’s physician-to-population ratio is significantly higher than the Unites States
overall ratio.
Pocahontas Memorial Hospital is a 25-bed, level-4 trauma center. A rural health clinic is located
within the hospital. The health clinic offers laboratory services, immunizations, disease
management, and monthly specialty clinics (cardiology, podiatry, and nephrology).
For more information about Pocahontas Memorial Hospital, visit the following website:
http://www.pmhwv.org/
Solution
Health care Limitations
Executive summary
The health care industry which is also known as the health economy or the medical industry is a
broad industry which specializes in the delivery of services regarding treatment of diseases,
conducting diagnostic services and therapies to identify various diseases so at to understand the
kind of treatment to be subjected to such diseases (World Health Organization. (2002). the
industr.
An Analysis Of Current Value-Based Payment Frameworks Applied In Oncology A ...Ann Wera
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photo 1.JPGphoto 2.JPGLESSON 16 Transition to Elec.docxrandymartin91030
This document provides information about a lesson on transitioning to electronic health records. The lesson objectives are to evaluate factors driving adoption of electronic health records. It includes readings from textbooks and instructions for activities and assignments. The key assignment is to research challenges of converting to electronic records and how it could address organizational challenges.
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
The document discusses the U.S. healthcare provider supply chain from a medical device perspective. It notes that healthcare costs in the U.S. are the highest in the world and are expected to continue rising faster than inflation. The Patient Protection and Affordable Care Act is driving major changes in how entities operate by implementing value-based healthcare. The goals are to improve care and population health while reducing per capita costs. This is causing shifts in how medical device companies, healthcare providers, and payers function and do business.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Medicine: A State of CRISIS, a State of CHANGELouis Cady, MD
Dr. Cady returns this year to repeat and update one of the most talked about presentations of the 2015 IMMH conference. In this presentation, Dr. Cady deconstructs the pressures and challenges facing patients, physicians, and all health care practitioners in today's practice environment. The role of integrated practice and functional medicine as a "differentiating factor" in one's practice is reviewed. The need for patients to adapt a healthy life style and take responsibility for their health for their own economic self-preservation is also touched on.
The keynote address discusses Massachusetts' efforts to expand access to affordable health care through comprehensive reform and the use of health information technology. The speaker outlines how Massachusetts passed legislation in 2006 that reduced the uninsured rate from 10% to 2.6% by requiring individuals to obtain coverage and providing subsidies. While successful, rising health care costs remain a challenge. Massachusetts passed a second phase of reform aimed at reducing costs through principles like improved primary care access and adoption of health IT. The speaker emphasizes the role of technologies like electronic medical records and remote patient monitoring in transforming care delivery to improve outcomes and lower costs. Massachusetts aims to have all residents' health information digitized by 2014 to create a more efficient and transparent system.
The Hudson Valley's healthcare system faces challenges in preparing for the aging baby boomer population. Hospitals have lower than optimal occupancy rates and quality measures, and many face financial difficulties. The region has at least 1,700 excess hospital beds projected through 2040. While nursing home needs will still increase even with lower admission rates, the region lacks sufficient home healthcare capacity and specialized facilities for conditions like Alzheimer's. Workforce development efforts are needed to meet projected growth in healthcare jobs. The report calls for greater regional coordination, integration of services, and planning to improve access, quality and affordability of care for seniors.
This document discusses priorities for health and social care reform in Australia. It argues that current boundaries between healthcare, long-term care, and retirement living are unsustainable. It also claims that payment systems for doctors and hospitals are outdated and impede integrated care. The document advocates for breaking down barriers between health and social care systems, changing payment incentives to focus on quality over quantity of care, and strengthening the linkage between medical and social care.
A National Health and Hospitals Network for Australia’s FutureOrthoSearch
The document outlines plans for major structural reforms to establish a National Health and Hospitals Network for Australia's future. The reforms include the Commonwealth becoming the majority funder of public hospitals, taking responsibility for GP and primary health care funding and policy, dedicating a portion of GST revenue to fund these changes, establishing local hospital networks to improve accountability and performance, and directly paying local networks for services provided rather than block grants. The reforms aim to address issues like an ageing population, workforce shortages, cost pressures, inefficiencies in the current system, and lack of local clinical engagement.
The document discusses the healthcare industry and provides context for analyzing delays in patient discharge processes at a hospital from May to July 2015. It describes the objectives of studying delays, the sample size, tools used, and limitations. It then provides an overview of the global healthcare industry, key segments including hospitals, providers and professionals, models for healthcare delivery, and the market size of the industry in different regions. Porter's five forces model is applied to analyze competition in the healthcare industry.
The document discusses innovation in the healthcare industry. It notes that the industry is ripe for disruption due to government mandates for digitizing health records and more people gaining health insurance under Obamacare. Speakers argue that healthcare needs transformation as the current system is unsatisfactory and costs are rising. The session will look at ways to spur innovation locally through partnerships between startups, universities, and other groups.
ReadingsHealth Care Reform and Future PossibilitiesIntroduct.docxsodhi3
Readings
Health Care Reform and Future Possibilities
Introduction
Health care has undergone episodes of major change since the introduction of Medicare in the 1960s. All of these have resulted in fundamental changes in how health care providers were paid for services to Medicare patients and were swiftly followed by matching changes from independent insurance companies. The latest, and some might say the biggest, change since diagnosis-related groups (DRGs) were introduced in 1983 is the signing into law of the Patient Protection and Affordable Care Act (PPACA), on March 23, 2010. This law proposes to change the delivery of health care services by changing how providers are paid and what they are paid for. This module explores some of the key elements of PPACA and how health care providers are planning their changes in delivery processes and systems in response.
Major Elements of PPACA
The most significant elements of the PPACA legislation are scheduled to take place over several years. Congress still has the ability to modify some of these elements, so we will examine them with that in mind.
June 2010
Adults with pre-existing conditions were eligible to join a temporary high-risk insurance pool run by the federal government. This will be replaced by a health care exchange in 2014, which will provide access to insurance at affordable rates. Applicants must have a pre-existing health care condition and have been uninsured in the six months prior to application. Premiums will be set at rates for the general population rather than the high-risk premiums charged by insurance companies. Out-of-pocket costs will be limited to $5,950 for individuals and $11,900 for families.
July 2010
The government established the National Prevention, Health Promotion, and Public Health Council, with the Surgeon General to act as chair of the council. This council will oversee the implementation of many of the PPACA elements and will disseminate recommendations to the health care community at large in regard to best practices in prevention and health promotion. As of fall 2010, little had yet been heard from this entity. However, the National Committee on Quality Assurance, which is a private entity dedicated to improving the quality of health care services, is providing best practices and quality measures for health care providers, especially hospitals.
September 2010
Insurance companies can no longer apply lifetime dollar limits on essential benefits for patients. In addition, children may be covered under their parents' insurance plan until they turn 26 years of age. This includes children not living at home, not listed as dependents on their parents' tax returns, not students, and children who are married. Further, no patients under 19 years of age with pre-existing conditions can be excluded from health care benefits based on the pre-existing conditions, and there can be no deductibles or copayments required for provision of preventive care measures and medic ...
This document is the January 2013 newsletter from ACOG District II. It provides updates on upcoming conferences and workshops on topics like practice redesign strategies and OB/GYN coding. It also summarizes new programs like the Resident Advocacy Program and initiatives around dense breast tissue notification. Special articles provide information on healthcare workforce trends in District II and the role of calcium and vitamin D supplements for postmenopausal women. The newsletter aims to keep OB/GYNs informed of changes and advocacy efforts regarding women's health in New York.
1. THE FUTURE OF THE CUBAN HEALTHCARE SYSTEM
LAUREN BOHABOY | AMINAH GBADAMOSI | JOE GERMINO
ALEX GOOD | ROB MCCURRIE
April 25, 2014
BA 30310
Section 2
2. 2
Table of Contents
Executive Summary……………………………………………………………………………….3
Abstract……………………………………………………………………………………………7
Introduction………………………………………………………………………………………..7
Background………………………………………………………………………………………..8
Current Assessment……………………………………………………………………………….9
Relevant Experts…………………………………………………………………………………11
Stakeholders……………………………………………………………………………………...13
Current Trends…………………………………………………………………………………...16
Key Challenges…………………………………………………………………………………..23
Baseline Forecast………………………………………………………………………………...24
Expected Future – Preservation………………………………………………………………….25
Alternative Scenarios…………………………………………………………………………….27
Uncertainties……………………………………………………………………………………..34
Business Implications……………………………………………………………………………36
Conclusion……………………………………………………………………………………….38
Works Cited……………………………………………………………………………………...40
3. 3
Executive Summary
The future of healthcare systems in developing countries is an interesting topic because
these countries usually have growing populations that will need adequate medical care at some
point in the future. Cuba is unique because it has managed to achieve health statistics similar to
that of developed countries like the United States with the economy of a developing country. The
fact that the current Cuban government offers free, universal healthcare makes this achievement
all the more impressive. However, the Cuban population is made up mostly of middle-aged
citizens, who will increase the demand for high quality healthcare as they begin to age. This
trend, along with the decaying nature of current medical facilities, outdated medical equipment,
and a relatively stagnant number of physicians in Cuba will ultimately put a great strain on the
healthcare system.
Currently the Cuban healthcare system operates around the idea of community-oriented
care, in which family doctors live within the
communities they serve. These family doctors are
relied upon for the majority of medical treatment,
and patients are only referred to hospitals when
their condition is severe. Hospitals and clinics,
therefore, are not the main avenue through which
care is received, and are utilized only in cases of complex procedures or severe illnesses. Due to
this lower reliance on such facilities, the upkeep of this infrastructure is not as much of a priority
to the Cuban government, leading to numerous decaying hospitals and clinics supplied with
outdated equipment. The majority of Cuba’s physicians are sent abroad by the government to
work in remote areas of other countries, which in turn pay a fee for these services. The Cuban
government collects the majority of this revenue, while the doctors themselves receive a very
4. 4
small portion. Clean water is available to the majority of the population, but in areas where such
a basic need is scarce this could cause increased health issues in the future. Additionally, the
current trade embargo with the United States has an impact on what types of medical products
Cuban citizens and doctors have at their disposal. As a result, Cuba has established a strong
biotechnology and pharmaceutical industry, developing and producing their own medications
and technologies. These current circumstances of the Cuban healthcare system aid in
determining the expected future of the system.
Projected out twenty years, the expected future sees little change in the Cuban healthcare
system from its current state. The government will continue to offer free healthcare to every
Cuban citizen, but this benefit will come at the price of lower quality of care. The bulk of the
population will have reached old age and will therefore demand more healthcare. Family doctors,
who serve the communities they live in, will continue to be relied upon for the majority of health
issues, while hospital visits will only be made when absolutely necessary. The issue of physician
brain drain will remain prominent, as many doctors will look to practice where they can earn the
highest possible salary, instead of remaining in Cuba where the compensation is minimal. The
infrastructure of these facilities will remain in relatively poor condition, and medical equipment
considered standard in any developed country would be absent from most of these facilities. The
embargo with the United States will continue, but relations will improve slightly, suggesting
progress towards an eventual compromise. The Cuban government will still restrict foreign
business from operating within the country in an effort to minimize outside influence. This lack
of change is due in large part to the unwillingness of the Cuban government to depart from
traditional policies, such as closed-door approaches to foreign imports, lack of adequate
investment in healthcare infrastructure, and the poor compensation given to doctors who are sent
5. 5
to work in other countries. This expected future, along with several alternative futures outlined
later in the report, are determined through the analysis of major trends that affect the system.
The future of the Cuban healthcare system can be better understood by identifying and
projecting the underlying key trends. These trends include the aging population, healthcare
expenditure, exports, and the number of physicians in Cuba. The majority of the trends will
increase demand for high quality healthcare, allowing endless opportunities within this industry.
Because the bulk of the population is beginning to enter old age, they will require more medical
attention, putting stress on a system that is already struggling to serve its currently young and
healthy citizens. The
government is charged with
supplying free, universal
healthcare to the nation, and in
order to improve the quality of
this care, funds must be
allocated to this sector. If healthcare expenditure remains stagnant as the population grows, the
quality of care will be compromised. A portion of these funds must go towards physician
salaries, a significant factor that will determine the number of physicians in Cuba. Again, if the
government continues to aggressively cut costs, this will negatively impact physician salaries
and likely cause the number of doctors in Cuba to decrease. These key trends will be crucial in
determining ways to improve the healthcare system as well as identifying major issues that stand
in the way of this improvement.
6. 6
These trends pose some challenges to the improvement of the current healthcare system.
Several key challenges include the financial costs of building additional infrastructure and
purchasing up-to-date equipment,
the Cuban government’s attitude
toward opening the economy to
foreign business and influence, and
retaining medical talent. These
challenges are especially daunting
when considering the fact that
Cuban healthcare has long been
universal and free to every citizen,
and that the government’s main goal is to maintain this policy. However, these trends also
provide opportunities for the system to improve, pinpointing the issues that will demand the most
attention in the coming years.
While the expected future is based on the extrapolation of current trends and expert
opinions, many uncertainties remain and have great potential to affect the direction of the Cuban
healthcare system. These uncertainties include the future political climate in both Cuba and the
United States, the financial future of Cuba in terms of the state of the economy as well as the
amount of government expenditure on healthcare, and the reliability of statistics coming out of
Cuba. These uncertainties provide the foundation for four alternative scenarios, which are
expanded upon later. In all scenarios, foreign relations with the United States and the level of
domestic action taken by the Cuban government impact physicians, infrastructure improvements,
and potential trade opportunities with the United States.
7. 7
Abstract
The purpose of this report is to explore the future of the Cuban healthcare system as it
relates to relevant trends and factors of change. This future will be determined first by analyzing
qualitative data along with expert testimony and then by extrapolating this data. The results of
this process have suggested that the likely scenario involves a greater demand for high quality
healthcare in Cuba while still maintaining the concept of free, universal healthcare for all
citizens. This increase in demand is due to a large aging population, increasing exports, and
decreasing healthcare expenditures. Additionally, medical facilities will need to undergo major
improvements in order to properly meet this demand. Equipment in these facilities also needs to
be updated, and doctors must be offered higher salaries as an incentive to stay and practice in
Cuba.
Introduction
Cuba is the most populous country in the Caribbean and has been moving toward a more
open economy, breaking away from its historically socialist closed-door policies. Since Cuba is
largely a developing country, and its population continues to grow, the future of its healthcare
system will be a major question in the next few years. This becomes very interesting as the
political environment continues to evolve in Cuba, especially as the country begins to open up to
the rest of the global economy, including the private sector. The scope of this project focuses on
the Cuban healthcare system as a whole, rather than specific sectors. When mapping the
overarching system in which Cuban healthcare lies, healthcare in developing countries acts as the
operating environment boundary, and the healthcare sector acts as the macro-environment
boundary.
8. 8
An assessment of the past and current state of the Cuban healthcare system is necessary
to project trends that will shape its future. The major stakeholders in Cuban healthcare will be
highlighted, as well as the drivers and constraints of change. The forecasts and future scenarios
formed through analysis of past and current trends will cover the next twenty years in order to
allow adequate political change. Finally, future business implications of these future scenarios
will be presented and examined.
Background
Following the Cuban Revolution in 1959, Cuba had similar health statistics to that of
third-world countries, leading the newly established Cuban government to announce that
universal healthcare would be a priority of the state. This initiated a mass exodus of nearly half
the nation’s physicians to the
United States in search of higher
salaries, leaving behind only
3,000 doctors to serve the nearly
six million citizens (World
Bank). The Ministry of Public
Health was established soon
after in 1960, and set out to
essentially build the nation’s healthcare system. The first goal was to alleviate health concerns in
areas previously deprived of care, and to achieve this there were teams of doctors sent out to
remote villages. Rural health centers were constructed with a focus on improving child health,
maternal care, and control of infectious diseases. These health centers, known as polyclinics,
9. 9
became the basic healthcare unit for the Cuban system, offering a broad range of medicines and
preventative treatments.
In the early 1980s, the Cuban government implemented a system of community-oriented
care that continues today, in which family doctors live in the community that they serve and
offer personalized medical care. If a patient required care beyond the capabilities or resources of
this family doctor, they would be referred to a specialized polyclinic or hospital. Therefore,
hospitals in Cuba play a different role in the system than American hospitals in that they are not
the main avenues through which care is received. Instead, they are utilized only in emergency
situations or if a patient’s condition is severe. The government has also instituted a program in
which they send Cuban doctors to nearby countries in need of doctors in exchange for a fee.
These doctors are often put to work in remote and desolate locations, and normally do not see
more than a third of the money paid for their services; the remainder goes to the Cuban
government.
Current Assessment
Today, Cuban citizens continue to receive the bulk of their care from the local family
doctor. As the population has expanded, the number of family doctors has risen. Currently there
are approximately 6 doctors per 1,000 people in Cuba as a result of this trend, up from about 5 in
1995 (Rogers). However, this number may be misleading if it includes the number of Cuban
doctors that are sent to work abroad instead of counting only the doctors that remain in the
country. In addition, family doctors are not equipped with adequate technologies or medicines to
deal with major emergencies, forcing patients to travel to faraway hospitals that still may not be
able to give them the treatment they need if they have obsolete equipment.
10. 10
Cuban healthcare facilities do not have much access to the basic technology seen in
similar American hospitals and clinics. Until
recently, Cuban hospitals did not have MRI
machines, and clinics did not have ultrasound
equipment. Currently, Cuba only spends about
$320 per year per person on healthcare,
compared to about $8,500 in the United Stated.
The majority of this is invested heavily in
biotechnology, especially pharmaceuticals (Cooper). As a result, the healthcare facilities in Cuba
are not as effective as they could be because they lack standard medical equipment and, in some
cases, are starting to deteriorate.
Many polyclinics are old and are becoming structurally unsound, and most are simply not
big enough to accommodate the growing population. Implementing new technology into
hospitals and clinics and making basic infrastructure improvements would allow patients to
receive higher quality of care, as well as faster diagnoses.
While not a major problem, the availability of clean water has the potential to impact the
healthcare system. According to The World Bank, 86% of Cuba’s population has access to an
improved water source. Comparatively 94% of Americans have access to clean water. The
reason for Cuba’s lower statistic is likely due to lack of availability of clean water in more rural
areas. Because clean water is necessary for basic sanitation and overall health, it has the potential
to affect the healthcare system. If someone doesn’t have access to clean water they are more
susceptible to diseases, which can also affect others in the community. While Cuba’s water
11. 11
availability has been increasing at a steady rate for over a decade, the government should look to
continue to improve it as they strive to become a fully developed country.
Cuba is also lacking “the most basic infrastructure requirement for progress in public
health”: a surveillance system that generates accurate data (Cooper). Measuring Cuban mortality
statistics against other Caribbean countries, it is apparent that the number of reported deaths in
Cuba is extremely low in comparison with their expected values. There is some controversy
around this as many skeptics suspect that the Cuban government is not being completely truthful
about their statistics. This is an attempt to make the country appear more stable and therefore
make the government itself appear more effective. However, this discrepancy could also be due
to flaws in the system. For example, 99% of infant deaths occurring in hospitals are reported on
the day of occurrence, while only 30% of infant deaths in the rural areas are reported on the same
day. If Cuba had more hospitals and other healthcare clinics, then mortality rates would likely be
reported much faster and more accurately.
Though the current state of Cuba’s healthcare system is in a slow decline, and the issues
involved with Cuba’s statistics, it is important to rely on relevant experts. These experts help
clarify what the current and future state of Cuba’s healthcare system is and what are possible
business implications to the system.
Relevant Experts
There are several relevant experts to refer to on the subject of the Cuban healthcare
system. One such expert is Melissa Rose Mitchell, MD, who has been very active in many
humanitarian causes and considers healthcare to be a social justice issue. She has also studied at
the Latin American College of Medicine. Another expert is Marcus Lorenzo Penn, MD. Penn has
visited Cuba twice with Medical Education Cooperation with Cuba. Penn is also the coordinator
12. 12
Melissa Rose Mitchell, MD
Dr. Cesar Chelala
of outreach through the Helen Diller Family Comprehensive Cancer
Center’s Department of Radiation Oncology. When Penn visited Cuba he
witnessed how their unique universal free health coverage teaches
citizens about healthy lifestyles and encourages them to understand the
importance of being healthy. From their experiences, Penn and Mitchell
both developed a greater understanding of how a medical system that is
run by the state can support and provide better public healthcare.
Dr. Cesar Chelala, a New York based physician, is another expert who is a global health
consultant and is also a contributing editor for The Globalist. Along with his contributions to The
Globalist, he has conducted health-related missions in over 45 countries
for several major organizations, including UNICEF and the WHO. In the
case of Cuba he suggests a dialog with the U.S. be conducted by a
commission of reputable medical professionals to evaluate the island’s
abilities to offer healthcare and negotiate the impartial channeling of
required goods and services to a people in need (Chelala). Though his
viewpoint and recommendations have been accepted by some, his ideas have been criticized by
some, including Dr. G Martin, and his colleague, Dr. Enrique Huertas. Dr. Martin is a practicing
physician in Kansas City, while Dr. Enrique Huertas is a prominent member of the Cuban
Medical Association in Exile (Chelala).
While these experts can be looked to for a more in-depth analysis of the Cuban healthcare
system, there is a general lack of experts on the subject due to the strictly closed nature of Cuba
itself. The government is very wary about letting foreigners in, as it prefers to keep intimate
details about the country and its systems hidden from the global public eye. Therefore, while
13. 13
experts on Cuban healthcare do exist, it is likely they have only been exposed to certain aspects
of the system, and may not have a total comprehensive view of the reality.
Additionally, again due to the secretive nature of the Cuban government, all statistics on
the current situation of Cuba as well as any future statistics coming out of Cuba should used with
some caution. There is evidence suggesting that Cuba inflates certain statistics in order to
maintain its image (Cooper). While experts help to generate more realistic and correct figures, it
is impossible to know the exact healthcare statistics as they pertain to Cuba.
Stakeholders
The future of healthcare in Cuba has important implications that affect a variety of people
and organizations. The following stakeholders have been identified based on their interest and
influence, and the focus of the project is largely those who have both high interest and high
influence. However, stakeholders in the position of high interest and low influence will also be
considered.
The stakeholder with arguably the most impact is the Cuban government. Because Cuba
is still a socialist country, the government has total control over all aspects of healthcare,
including physician salaries, the quality of medical facilities, and the equipment in these
facilities. The government also controls the degree to which foreign organizations such as for-
profit businesses are allowed into the country. Historically, the Cuban government has
implemented a strict closed-door policy. Cuba is still wary of letting foreign businesses into the
country, but recently they have opened up to NGOs, or non-government organizations, implying
that they may be more lenient with for-profit businesses in the future. While the government
regulates the healthcare system, it is also influenced by it in return. Healthier citizens make for a
more productive and efficient economy, which is especially crucial in a socialist country that
14. 14
depends on the effort of its citizens to produce goods and services for the population. Because of
the currently high level of control the government has over the healthcare system in Cuba, they
are considered to be the stakeholder with both the highest influence and the highest interest.
Another important group of stakeholders in healthcare are the private interests,
particularly pharmaceutical companies. While they do not have nearly as much influence as the
government, they have a very high level of interest because the healthcare system is a major
driver of their profit. Because Cuba tends to shy away from foreign imports, they are forced to
manufacture their own medications. Therefore, as the bulk of the Cuban population continues to
age, pharmaceutical companies will likely see sharp increases in demand for their products.
These private interests also influence the system based on how much they choose to charge
either for medical care or medications. Charging higher prices for necessary medications may
force people that need them to forgo the purchase, and as a result become sicker and put a
heavier burden on the system.
The citizens of Cuba themselves have a very high level of interest in the future of the
Cuban healthcare system, but they have much less influence. Universal healthcare has been a
priority of the state since the early 1960s, and the
Cuban population has come to view it as a birthright.
However, because Cuba is a socialist country the
citizens are completely dependent on the government
for the quality of healthcare they receive. As costs for
the government rise in coordination with a rising
population, the quality of this care is jeopardized. Ultimately, this impacts the Cuban citizens
themselves, and therefore they have a great interest in the future of this system. Additionally,
15. 15
parts of the rural population of Cuba still struggle with access to clean water, which could have a
negative health impact if the problem is not addressed. While the government is very dominant
in its control over the healthcare system in Cuba, the citizens themselves do have a chance to
have some influence. As already mentioned, the state depends on the work of its population in
order to function, and if these people are not healthy then the state is at risk. In this way, the
general population does have influence on the future of the system.
Doctors and Cuban medical students are stakeholders at the same level of influence and a
slightly higher level of interest as normal citizens. This group cares a great deal about the
healthcare industry because it will shape their own livelihoods, designating them a higher interest
level than a typical citizen. Because most doctors in Cuba live in the communities they serve,
they develop an even stronger personal interest in public health, and with it a “strong sense of
humanitarianism,” according to expert Marcus Lorenzo, who has witnessed this personally in
trips to Cuba. Doctors are also very concerned about their ability to make money and pay off
possible medical school debts. Therefore, if the salaries in Cuba are not high enough, they will
not hesitate to leave. Currently there is a program in which the Cuban government pays for
medical school in exchange for the student to remain in Cuba after graduation and work in an
underserved community, but this incentive is still not enough. In 2013 alone, 29,712 people
graduated from Cuban medical schools but because of the low salaries available to doctors
within Cuba, most doctors leave (Delgado Legòn). Because doctors are such a major component
of the healthcare system, they are likely to have some influence on its future. If doctors continue
to be unsatisfied with their compensation and they leave the country as a result, this will
negatively impact the entire system.
16. 16
Other countries, especially developing countries, have a fair level of interest but little
influence on the Cuban healthcare system. The system is a model for developing countries
because they have effectively lowered infant mortality rates and raised life expectancy to the
levels of developed countries while having the economy of a developing country. Developing
countries like those in Africa and the Middle East can look to Cuba as an example and
implement policies that fit the unique conditions they face individually. This model for universal
healthcare can also apply to developed countries, like the United States, who are still looking to
improve upon their own systems. Additionally, outside countries may have newly discovered
business interests in Cuba if the government decides to open the country to foreign trade.
However, these countries currently have very little impact on the Cuban healthcare system
because of the high-level government control in regards to outside influences.
Current Trends
In order to project the future of the Cuban healthcare system, significant trends are
identified as drivers or constraints of change and then extrapolated using past data.
Aging, Educated Population
Cuba, much like the rest of the world, is dealing with an aging population. In 1997 13.1%
of the population was over the age of 60,
and this number is expected to rise to
24% of the population in 2025 (Cuban
National Statistics Office). This aging
market will place a heavy burden on the
healthcare system due to their increased
needs for medication and higher
Figure 1: Cuban Population Distribution by Age
17. 17
frequency of doctor visits that come with old age. This increase in demand for healthcare will
likely be amplified because 35% of adults in Cuba smoke and 69% of adults suffer from
hypertension; these rates are almost double those of the U.S. (National Statistics Office, Fast
Facts). However, the Cuban population is growing at much slower rates than other developing
countries, due largely in part to widespread sex education. The Cuban contraceptive prevalence
rate is 74.3%, compared to the world average rate of 63% (Central Intelligence Agency,
Contraceptive Prevalence Rate). Higher levels of sex education allow for fewer unnecessary
births, and this makes for a smaller burden on the nation’s healthcare system. In contrast,
developing countries in Africa with lower levels of sex education typically have more problems
with their systems simply due to the volume of people. More people with the same amount of
doctors puts a much larger strain on the system, leading to lower quality care. The population is
still growing very quickly, and therefore demographic changes will be a driver of change in the
healthcare system.
A metric that can be used to project the trend of the aging population is the age
dependency ratio, a measure of the number of people from age 0 to 14 and 65 or older divided by
the number of
people from 15
to 64. These
numbers
generally
signify the ratio
of people in the
labor force and
Figure 2
Source: Index Mundi
18. 18
those who are not, usually young children and the elderly. Therefore, there is pressure on the
labor force to provide for those who do not work. A high ratio means that those working face a
greater burden trying to support children and the elderly, and vice versa. From 1960 through
1970 Cuba faced a “baby boom” in which the average woman had 4.5 children, an increase from
about two children in the years prior. This baby boom was largely due to the higher quality living
conditions of this time as well as widespread optimism about the future. After the 70’s, women
on average had less than two children, a trend that has continued into the present. As Figure 1
shows, the baby boomers are now in and around their forties, and they will cause problems in the
age dependency ratio when they retire. Figure 2 depicts the likely increase in the age dependency
ratio that will result from the aging of the baby boomers. This problem will likely be amplified
by the smaller generation that will follow, as they will be charged with the task of supporting the
baby boomers once they reach the labor force. This support will include providing adequate
healthcare, placing a major strain on the entire system.
Physicians
The growing population makes the number of physicians in Cuba a major driver of
change for the
future of the
country’s
healthcare
system because
more doctors
will be needed
to serve more
Source: Index Mundi
Figure 3
19. 19
people. In order to keep the number of doctors in check with the rising population, the Cuban
government offers incentives for them to stay in Cuba. Cuban physicians receive government
benefits such as housing and food subsidies, and the government also offers to cover medical
school costs (Campion). Cuba currently has about 6 physicians per 1,000 people, compared to
the 1.76 physicians per 1,000 in Cuba’s major trade partner, Brazil, and 2.42 per 1,000 in the
United States (Central Intelligence Agency). While these statistics may look promising, it is very
possible this number includes the number of Cuban doctors who are sent to work abroad, instead
of only including the doctors who live and work in Cuba. Therefore, the true number of
physicians in Cuba could be much lower depending on how the statistic was calculated.
While recent data shows that the number of physicians has increased in the past decade,
there are concerns that this number may plateau or even decrease. This concern is mostly due to
the currently low physician salary, which is causing many doctors to leave the country in search
of higher compensation (Central Intelligence Agency). Doctors in Cuba only make about $240
per year, compared to the average $191,520 doctors in the U.S. are paid (Campion, and
Physician: Salary). Mechanics and waiters can earn more than a Cuban doctor practicing in
Cuba. This could also potentially dissuade other Cubans from pursuing a medical career, leading
to a further decrease in the number of physicians. A lack of qualified medical professionals
would mean that Cubans would be unable to receive the care they need, causing the general
health of the population to suffer as well as the entire system to suffer. Therefore, the number of
physicians is considered a constraint of change in the Cuban healthcare system.
Healthcare Expenditure
Healthcare expenditures are also an important trend to analyze in order to determine the
future of the Cuban healthcare system. As a Cuban, free healthcare is essentially considered a
20. 20
birthright, but maintaining the system is difficult as the population continues to grow. As Figure
3 shows, healthcare expenditures began to fall in 2009, 2010, and 2011. According to Cuban
officials, this is a result of the government’s attempt to increase efficiency within the system.
The government closed more than 54 hospitals and more than 400 clinics in 2011 in order to cut
costs (Cuba Trims Healthcare Par.2). In an attempt to keep universal healthcare a reality, the
Cuban government is cutting costs, but ones that are extremely vital to the whole system itself.
After analyzing past data, healthcare expenditure is projected to decrease, as depicted in
Figure 3. This is largely due to the Cuban government’s attempts to cut costs in order to preserve
the concept of universal
healthcare. Unfortunately,
this current policy of
spending contraction has a
negative impact on the
healthcare system.
According to patients,
costs are being cut in the
most basic areas; patients
have to bring their own
food, water, bed sheets, and fans to hospitals/clinics (Barghi Par. 8). Basic things such as medical
equipment and soap are scarce in hospitals. Even the hospitals themselves are in bad condition,
as many are beginning to decay. Decreased spending has also affected physician salaries because
the government is responsible for paying doctors. Doctors are receiving lower salaries and many
are leaving in search of better compensation, causing lines at hospitals and clinics are getting
Source: World Data Bank
Figure 4
21. 21
Source: Trading Economics
Figure 5
longer due to smaller staffs. The Cuban government wants to continue to offer free, universal
healthcare, but these costs are quickly beginning to add up, and this balance will become harder
to maintain as time goes on. Whatever changes are ultimately made, Cuba must ensure that these
improvements are realistic and affordable, in that they meet the needs of the people without
crippling the government’s ability to spend money elsewhere.
Exports
Cuba’s exports serve as an indicator of where Cuban healthcare is likely to go, as they
can help determine the state of the economy as well as gauge possible government leniency on
allowing foreign imports. As depicted in Figure 4, Cuba has experienced a large increase in
exports in recent years, and this number will likely continue to rise. Cuba’s top export is hired-
out professional services, with medical services making up the majority. Cuba sends doctors to
countries in need to help in underserved areas in exchange for a fee. These doctors are often sent
to remote locations
and are forced to
work in very harsh
conditions. The
doctors only see a
fraction of this
money while the
Cuban government
pockets the rest. Figures on physician salaries while abroad are uncertain, but the fact that no
data is available demonstrates that the Cuban government may be taking advantage of these
doctors. Cuba earns over $6 billion a year from this practice, and there are currently around
22. 22
40,000 Cuban doctors working in over 66 countries around the world, of which 40 receive these
services for free (Cuba Nets Billions Each Year Par. 3). According to Bloomberg Business
Week, Cuba’s government forecasted that it will earn around $8.2 billion from sending nurses
and doctors abroad (Cuba Forecasts $8.2 Billion Par.1). Because it is such a lucrative practice,
Cuba wants to increase the number of doctors exported, and both for profit and for free to
countries in need. Exporting to these non-paying countries will mean lower salaries for
physicians, which could have problematic effects.
A major consequence of this practice is that fewer and fewer doctors will want to work in
Cuba due to fear of being sent abroad to work in poor conditions or to avoid a lower salary than
they can get elsewhere. Additionally, the doctors who do stay will most likely be less skilled than
the doctors that are sent abroad because the more talented doctors will be the ones with the
highest earning potential. Cuban healthcare will continue to struggle due to this program, but it
seems to be a priority for the Cuban government due to the high amount of revenue it returns.
Cuba also has strong pharmaceutical and biotechnology industries that contribute
significantly to the exports. Because of the trade embargo with the U.S., medications cannot be
imported from American pharmaceutical companies. As a result, Cuban pharmaceutical
companies develop and produce medications for both domestic use and international trade.
Historically Cuba has had a strong focus on biotechnology, investing at least $1 billion in the
industry over the past 15 years (Carr Par.4). As a result of this investment, the entire sector is
expected to double in the next five years, adding over $5 billion in export revenues (Central
Intelligence Agency). This significant portion of the economy devoted to the medical industry
has the potential to affect the entire healthcare system. As this sector of the economy expands,
medications will become more widely available due to lower prices. This will, in turn, increase
23. 23
Cuban exports as other countries look to take advantage of these advancements, and will
ultimately drive the healthcare system as a whole.
Key Challenges
Attempts at improving the current healthcare system in Cuba will be met with several
challenges, one being the high cost of building and improving upon existing medical facilities
and equipping them with the necessary equipment. Most hospitals and clinics are deteriorating,
they lack the most fundamental medical equipment and medicines, and they are in desperate
need of updating (Scheye). Until recently, these facilities did not even have MRI machines,
equipment considered standard in any American hospital, resulting in a lower quality of care for
patients. Since Cuba is a socialist country, the government has complete control over the
healthcare system and the funding it receives. However, the government is also responsible for
providing free healthcare to every Cuban citizen, the cost for which continues to rise as the
population grows. The challenge will be ensuring that Cuban citizens still receive high-quality
care while allowing the government the flexibility to allocate funds to other areas, such as
national defense.
Another factor that may prove problematic is the Cuban government’s attitude toward
foreign imports. In order for Cuba to gain access to the updated medical technology its hospitals
need, foreign trade is necessary. An open-door trade policy could also benefit the healthcare
system by allowing construction companies to offer cheap solutions to the infrastructure
problems mentioned above. Additionally, allowing goods to flow freely between Cuba and
outside countries will improve the country’s overall economy, which would then enable the
Cuban government to spend more money on healthcare. However, if the Cuban government
24. 24
remains strict on the subject of foreign imports, improvement of the healthcare system could be
difficult.
A final challenge that may be encountered is the drain of medical talent to other
countries. Since Cuban doctors earn significantly less in Cuba than they could in other countries,
they have very little incentive to remain in the country. If too many physicians decide to leave,
this will create a shortage of doctors and put a major strain on the entire healthcare system. The
Cuban government is responsible for paying these doctors, and if they are not offered
competitive wages the entire healthcare system could be affected.
Baseline Forecast
Cuba has been praised for having the health statistics of a developed country while
having the economy of a developing country, an achievement made possible through universal
healthcare. For example, the reported life expectancy in Cuba is 76-80 years, similar to that of
the U.S. Additionally, the probability of dying under the age of five is .6% in Cuba compared to
.7% in the United States (WHO). However, given the current trends in the population, healthcare
expenditures, number of physicians, and exports, the healthcare system is likely to change in the
future.
The aging population will be the most important driver of change within the healthcare
system. The majority of the population is made up of middle-aged adults, who will put a strain
on the system as they continue to age and demand more healthcare. Potential issues will arise if
healthcare expenditures continue to level off, resulting in decreased quality of care for the sake
of decreased costs to the government. This in turn may affect the number of physicians in Cuba,
who are dependent on the government for their salaries. If they feel they are not being paid
enough, doctors will leave the country in search of better compensation, further compromising
25. 25
Good Foreign Relations with U.S.
Bad Foreign Relations with U.S.
Domestic ActionLack of Domestic Action
the quality of Cuban healthcare. Future leadership will also have an extraordinary impact on the
future of the Cuban healthcare system. Raul Castro’s announcement to leave power in 2018 has
created the possibility for political change in Cuba, including opening up the country to foreign
imports. This potential shift in power could have a considerable impact on the future of the
healthcare system, but without it, major changes in the system are unlikely.
Expected Future – Preservation
There are several different possible futures that could occur based on the relations with
the U.S. and the level of domestic actions. The future scenarios are illustrated on both a micro
and macro level by the following fictional account of a seven-year-old Cuban boy named Luis.
One morning, Luis, a seven-year-old boy who lives in a small village in Cuba, gets
kicked hard in the shin while playing soccer with his friends. After his mother inspects the
injury, she decides a doctor’s opinion is needed to determine if his leg is broken. She phones the
local family doctor, Dr. Hernandez. Dr. Hernandez comes to Luis’s home to do some basic
International
Focus
All-Inclusive
Focus
Non-
Inclusive
Focus
Home Focus
Preservation
26. 26
medical tests, examining Luis using the very little equipment he has. Dr. Hernandez ultimately
diagnoses him with a bone contusion, but he wishes he could have done more extensive tests to
make sure that the bone is not broken, possibly with an X-ray machine. Unfortunately, Dr.
Hernandez does not have access to such technology, and the local hospital has run so low on film
necessary to run the X-ray machine that they are reserving the film for more crucial and life
threatening cases. Luis is instructed to take it easy for the next few days, and the doctor believes
the contusion will heal itself within the next few weeks.
The expected future of the healthcare system involves very little change from the current
circumstances. Family doctors will continue to be heavily relied upon for the majority of medical
issues, and patients will only resort to
visiting a hospital if the injury or illness
is severe. Hospitals and clinics will
remain outdated and the medical
technology inside will become
increasingly obsolete. There will not be
enough qualified doctors to meet the
demand of the population because most
doctors that choose to stay in Cuba are sent off to work in other countries, a continuing source of
revenue for the government. The embargo with the United States remains, although there have
been recent talks between the countries of reaching a trade agreement. Until that time, the Cuban
government continues to restrict foreign businesses from operating within Cuba.
27. 27
Signposts
There are a variety of potential signposts that are associated with the expected future
scenario. A continued increase or no change in the number of Cuban doctors leaving the country
to work elsewhere could indicate that the Cuban government has refused to increase healthcare
expenditures and that working conditions for doctors are not improving. As a result, the quality
Cuban healthcare is likely not improving or possibly worsening due to a shortage of qualified
doctors. Additionally, the continuance of the trade embargo with the United States accompanied
with strong political leaders of both countries publicly stating a refusal to work with the other
would be another strong indicator that Cuban healthcare is not improving. If one or both of these
signposts are observed, there will be sufficient evidence to suggest the expected scenario is
occurring.
These are the some major signposts to look out for but this is not an all-inclusive list.
Entrepreneurs should be aware of any other signposts closely related to these that indicate
worsening international relations or decreasing domestic action, as these are also signs that the
expected future may be occurring.
Alternative Scenarios
When looking at alternative scenarios there are a couple other possibilities for how the
Cuban healthcare system would treat Luis.
28. 28
All-Inclusive Focus
Luis’ mother takes him to one of the many
hospitals that serve the area, hopeful because this
hospital just received some new medical
equipment from the United States. In the hospital,
they have no problem finding a doctor to consult,
who diagnoses a bad bruise with the help of the
new X-ray machine.
Cuba’s relations with the United States are the best they have been since before the Cold
War. While Cuba still has marked characteristics of a socialist economy, such as the lack of
private doctors and hospitals, the two governments have lifted the long-lived trade embargo and
• Doctors stay in Cuba, are paid more
• More infrastructure
• Accurate medical statistics (no embargo)
• Perfect relations with U.S.
All-In Focus
• Doctors stay in Cuba, are paid more
• More infrastructure, but could be expanded further
• More clinics
• U.S. embargo still in effect (relations still strained)
Home Focus
• Lack of doctors due to inadequate salaries
• Lack of infrastructure
• Better medical technology, accurate medical statistics
• Perfect relations with U.S. (no embargo)
International
Focus
• Lack of doctors due to inadequate salaries
• Very little infrastructure
• Limited medical technology
• U.S. embargo still in effect (relations are strained)
Non-Inclusive
Focus
29. 29
allowed goods to flow freely between the two countries. This attracts entrepreneurs of all kinds,
both native Cubans and Americans, looking for new niches and markets to explore within Cuba.
This economic freedom allows more advanced medical technologies, including
equipment and medicine itself, to be easily implemented in Cuba. Additionally, more and more
doctors are remaining in Cuba to practice after
they graduate medical school due to the higher
salaries now available to them. New hospitals
and clinics are built in order to best serve the
health-related demands of the growing
population, and clean water is available to
every Cuban citizen. These factors will enable
medical professionals to give better treatment
to their patients, and thus result in a healthier population overall. The Cuban government is also
now willing to report accurate medical statistics.
Signposts
There are several potential signposts associated with this alternative scenario. First, if
political candidates begin to place an emphasis on improved relations between Cuba and the
United States, this would be a strong indication of a collaborative future between the two
countries, especially if these candidates are elected demonstrating the public’s desire to repair
relations with Cuba. Also, if reports start to surface of the United States’ desire to lift the
embargo at any time in the near future, this can prove to be another strong indication of
improving relations. Additionally, it is crucial for this scenario to come to fruition to see
increasing domestic action in the healthcare sector. One of the major signposts associated with
30. 30
increased domestic action is a lower defection rate of Cuban doctors. Less doctors leaving could
be signs of higher salaries and improved working conditions, which are indicators that the Cuban
government is taking more domestic action.
Home Focus
Luis still has options available to him in terms of getting the care that he needs, but he
has to travel a bit farther because the nearest full-service hospital is a few more miles from the
local clinic that serves his village’s minor needs. The hospital does have a full staff of doctors
and the equipment necessary to make a complete diagnosis, which is the reason he and his
mother are willing to travel.
Doctors that have been educated in Cuba’s exceptional medical schools are willing and
motivated to stay in Cuba for their careers, as their salaries now compete with those of other
countries like the United States. Treatment
of injuries and illnesses are improved due to
this fact, as well as the increased number of
formal hospitals within Cuba. This new
infrastructure is an important step to
providing the best possible healthcare to its
citizens, but the Cuban government still has areas in need of such improvements. The health of
the rural population has also gotten better as clean water has become available to almost
everyone. Relations with the United States are still strained, and there are no signs of any open-
mindedness by either nation.
31. 31
Signposts
There are many potential signposts associated with this alternative scenario. If political
candidates start to focus on and discuss improving relations between Cuba and the United States,
this would be a strong indication of a much better future between the two countries. If the
potential candidates were elected, this would indicate that the public has a strong desire and
realized the importance of repairing relations with Cuba. If reports are brought up about the
United States’ aspiration to lift the embargo in the near future, this could potentially prove to be
another strong indicator of improving relations. If more people are healthy and the number of
people going to the hospital decreases. This can be an indication that the scenario is occurring. If
less doctors are leaving could and staying to work in Cuba, this could be a result of higher
salaries and improved working conditions which are both indicators that the Cuban government
allocating more money towards their healthcare.
International Focus
Luis’s mother takes him to the local clinic to get his leg treated. Although the clinic does
not have a full staff of doctors, the medical technology brought in from America helps to
alleviate this and returns a proper diagnosis of a bad bruise instead of a fracture.
Relations between the United States and Cuba are very strong: the trade embargo of
previous years has been lifted, allowing goods such
as the medical technology mentioned above to reach
Cuban citizens in need. Cubans and Americans alike
are able to start their own businesses in Cuba as the
government permits more and more private
entrepreneurship. In tune with a more open economy,
32. 32
the Cuban government begins to release more accurate statistics reflecting the state of the entire
population, not just the subsets that paint the overall health of the population in the best light.
The country is still lacking in medical infrastructure though, particularly hospitals. While
there are local family doctors that can tend to basic injuries and illnesses, hospitals are needed to
better serve all the needs of the population. Doctors are still paid much less in Cuba than in the
U.S., and therefore most of them leave the country after completing medical school. The ones
that do stay are commissioned by the government to work in other countries. These doctors often
work in remote locations in these countries and typically only see a third of the total pay they
earn, while the rest goes to the Cuban government.
Signposts
There are several potential signposts associated with this alternative scenario. If political
candidates begin to focus on improving the relationship between Cuba and the United States, this
would be a strong indication of a strong future between the two countries. If these candidates
were elected this would clearly demonstrate that the public has a strong desire to repair relations
with Cuba. If the United States’ desire to lift the embargo at any time in the near future starts to
be discussed, this could potentially prove to be another strong indication of improving relations
between the two countries. An increase in both Cuban and American doctor’s starting their own
practice in Cuba would also be an important indicator of a more open economy. More advanced
medical equipment in hospitals may also be a sign that the relations between the two countries
has improved and that the United States is helping Cuba improve their medical equipment.
33. 33
Non-Inclusive Focus
Luis has very few options for tending to his injured leg. His mother finds one of the local
doctors who is currently working at one of the few area clinics, knowing full well that there will
likely be very outdated (if any) medical technology to aid in a diagnosis.
There is a general lack of doctors as well as infrastructure. Any doctors that stay in Cuba
to work are paid dismal salaries for
their work, resulting in a major
brain drain to other countries
offering higher pay. There are very
few clinics, and even fewer actual
hospitals within the country,
severely limiting the options for
care for Cuban citizens.
Additionally, clean water has become even scarcer in rural communities, resulting in
more health problems in these areas. Relations with United States are still tense, as the trade
embargo between the countries continues due to inability of both countries to reach a
compromise. Goods are unable to pass between countries, especially important medical
technology that is crucial for the Cuban population. Success in private entrepreneurship in Cuba
is very rare due to tight government control.
Signposts
There are many potential signposts that indicate that this scenario is occurring. Cuba is
usually very secretive and strives to maintain a strong image for its government; any reports
leaking through the media of worsening conditions or declining medical schools would be a
34. 34
major indicator that this scenario is occurring. If one or both of these signposts are observed,
there will be sufficient evidence to suggest the scenario may be occurring. If people are
beginning to get sick do to a lack of clean water, quality infrastructure, and medical equipment,
this indicates that Cuban healthcare is progressively getting worse.
Uncertainties
One of the most critical uncertainties faced by the healthcare system is the future political
climate both in Cuba and the U.S. Projecting trends
twenty years into the future should allow ample time for
the current Cuban president Raúl Castro to vacate his
position. Because the Cuban government controls all
aspects of the healthcare system, the leaders at the helm
of this government will essentially determine the future
of this system. In recent years, Cuba’s government has been moving away from the traditional
hardline socialist approach, allowing NGOs into the country. However, there is no guarantee as
to what types of policies Castro’s successor will implement; he may continue to tentatively
explore open trade and increase healthcare expenditure, or he may revert back to the traditional
closed-door policies of the past. While the Cuban government is one of the most important
factors to consider in determining the future of the healthcare system, there is a large degree of
uncertainty associated with it.
The future of the political landscape in the U.S. also remains in doubt. While the U.S. is
currently led by President Barack Obama, a Democrat, there is no way of knowing which party
will be in the White House in twenty years’ time. Determining how dedicated the U.S. will be in
attempting to repair its relationship with Cuba will depend largely at the leadership of the time.
35. 35
Currently, a trade embargo between Cuba and the U.S. is in effect; however, Hillary Clinton, the
former U.S. Secretary of State, recently suggested that the U.S. is “open to changing with
[Cuba]” and ending the embargo. If the embargo were to be lifted, this would open up
tremendous opportunities for U.S. businesses in Cuba, especially within the healthcare sector.
Unfortunately, political climates are constantly changing and are nearly impossible to predict.
Therefore, these conditions will be a major uncertainty moving forward.
Another significant uncertainty is the financial future of Cuba. With these potentially
changing political conditions, Cuba could see a dramatic change in GDP if the embargo is lifted,
likely experiencing significant growth as increased exports and imports allow more healthcare
spending. Cuba is also typically rather secretive about its government spending, and the
information that is available is subject to much speculation. This is a problem because there is no
guarantee as to historically what percentage of Cuba’s GDP has been spent on healthcare,
making it difficult to project future spending. Given current circumstances, there is no assurance
as to if Cuba will have the means or the willingness to commit to this type of spending.
As mentioned above, a final uncertainty is the lack of reliable statistics coming out of
Cuba. The current situation in Cuba is not completely transparent because many of the statistics
may be inaccurate. This makes measuring improvement going forward very difficult. Many
observers are skeptical, stating that “the number of deaths attributed to ill-defined causes is very
low (0.7%), an important indicator of incomplete or inaccurate vital statistics” (Cooper). Many
medical experts believe that Cuba is inflating statistics such as the country's mortality rates as
well as life expectancy rates. There is also evidence to suggest that doctors are forced to abort
babies in problem pregnancies before the 21-week mark, at which the child would be counted
towards the mortality rate. Unfortunately, issues like these make it impossible to know the exact
36. 36
conditions in Cuba. Personal testimonies from Cuban physicians and experts who have visited
Cuba indicate that the situation is worse than the public statistics dictate, but it is impossible to
know exactly how much worse. This uncertainty makes accurately determining the future of the
healthcare system very difficult. Therefore, the projections made are based on published
statistics, with the realization that these statistics may very well be misleading.
Business Implications
After examining the current state of the Cuban healthcare system, associated trends, and
determining expected and preferred futures along with alternative scenarios, there are several
significant business implications that emerge from the Cuban healthcare system. Given the fact
that the government still has extensive control over entrepreneurship opportunities in Cuba, all
business implications will likely involve some type of negotiation with the Cuban government.
Currently one of the most crippling aspects of the Cuban healthcare system is the lack of
adequate infrastructure, such as hospitals and clinics. If domestic action improves in Cuba and a
greater emphasis is placed on developing adequate infrastructure, we can expect to see some
business opportunities for several different companies. For example, construction companies that
can negotiate with the Cuban government and offer them fair and low prices for such
developments have some major opportunities in this area. These opportunities could be even
more extensive if such companies can offer sustainable infrastructure at lower costs, which will
ultimately lower the cost of maintaining these buildings in the long run. As the Cuban population
grows, providing necessary health-related infrastructure will be essential to maintaining a healthy
working population and, as a consequence, a properly functioning and efficient economy. As
stated above, these opportunities are most likely to occur with improved domestic action in
Cuba. Therefore, these business implications only exist within our All-Inclusive Focus and
Home Focus scenarios.
37. 37
Cuba will also likely experience a need for more advanced medical technology, including
equipment and medicine. The research and development costs associated with this technology
are too great for Cuba to develop it on its own. Instead, in order for Cuba to make medical
advancements with new technology, there will need to be a greater domestic emphasis on
spending on these technologies as well as improved government relations with the United States
and repeal of the trade embargo so that Cuba may purchase these technologies from a country
that has already developed them. If this occurs, substantial opportunities will exist for companies
that are able to supply them to those in need, especially as the complementing infrastructure will
begin to emerge. Additionally, doctors will want to work in more advanced facilities with newer
technologies more than older facilities with obsolete technologies. Therefore, if the Cuban
government increases physician salaries in an attempt to keep doctors in Cuba, they will likely
reinforce the desire to stay through investment in such technologies. This business opportunity
only exists in the All-Inclusive Focus scenario because it requires both domestic action and
improved foreign relations.
While clean water is available throughout the majority of the country, approximately
15% of the population is still without access. This lack of availability is mostly restricted to the
rural areas of Cuba. Advancements have already been made in cleaning up the water supply in
Cuba, but more must be done. As a result, while it is feasible for Cuba to have a clean water
supply under current circumstances, increased domestic action will most likely be necessary. As
such, businesses relating to water storage and transportation infrastructure could benefit from
this opportunity, as Cuba strives to make clean water available to all citizens. These businesses
have potential to thrive under all scenarios but will most likely succeed in the All-Inclusive
Focus and Home Focus scenarios.
38. 38
Finally, easing tensions between Cuba and the U.S. in recent years can have very
significant and legitimate business implications, especially if the trade embargo between the two
countries is either altered or lifted completely or if the Cuban government increases domestic
action and focus on its healthcare sector. These developments have the potential to up an entirely
new market for healthcare companies, both domestic and foreign, for everything from consumer
goods to healthcare-specific goods like medical technologies.
Conclusion
Cuba’s healthcare system, as it stands, is filled with medical facilities that are inadequate
and incapable of filling the needs of the Cuban population. After considering that the drivers and
constraints of change - the aging and educated population, healthcare expenditures, and exports -
and how they affect the stakeholders in the system - the Cuban government, private interest,
doctors, the Cuban citizens, and other countries - the Cuban healthcare system is likely to remain
a system that is failing to take care of the citizens that rely on them.
If current trends continue, which is the expected future, the Cuban government will
continue to minimally finance the healthcare industry. The limited interactions with foreign
entities and private interest, especially pharmaceuticals, do not allow for further growth and
development to the system. Doctors will continue to be paid minimal salaries, and work in
conditions far from ideal. The quality of care will continue to be inadequate, and with the
growing population, more stress will be put on the doctors that care for the citizens they serve.
Though the expected future is not ideal, there is hope that through partnerships with
businesses, relations with foreign entities, and the continual domestic action to improve the
system, the possibility of having a system that will fully cater to the needs of an aging and
growing population is possible. The implementation of better infrastructure that would not only
39. 39
allow for 100% of the population having access to clean water, services that provide preventative
and diagnostic medicine, as well as the improved treatment and pay of doctors, would be a major
indicator of a healthcare system moving in the ideal direction.
Unfortunately, without the encouragement of these business ventures from the Cuban
government, Cuba’s ability to supply sufficient free healthcare will no longer be possible. These
opportunities in the All-Inclusive and Home Focus scenarios are essential, because with the aging
of the baby boomer population, the working force is not large enough to support the needs of this
aging population. The partnerships and relationships the government would create, would allow
for private businesses to not only ease this pressure off the Cuban government, but provide
preventative care services, like vaccines, that would decrease overall healthcare expenditures and
help increase the health of the Cuban population.
If there is either increased domestic action or improved foreign relations, multiple
business opportunities in the Cuban healthcare system will drastically improve the quality and
efficiency of the system in place. However, caution must be exercised, as these businesses
opportunities primarily exist in the alternative scenarios. If the expected future occurs, minimal
business opportunities will exist in the Cuban healthcare sector as the system overall deteriorates.
It is important to watch out for the signposts associated with each of the alternative scenarios, as
tremendous business opportunities may exist with increased government action either
domestically or internationally.
40. 40
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