Cuba's health care system


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Cuba's health care system

  1. 1. + Health care system in Cuba 郭乃文 李翰泓 陳崇崢
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  3. 3. 世界衛生組織古巴衛生狀況數據 男性/女性預期壽命(歲): 76.2/80.4 嬰兒死亡率(每千人): 4.9 15至60歲男性/女性死亡率(每千人): 120/78 每千人擁有醫生(除牙醫)數: 6.8 每千人擁有牙醫數: 0.87 每萬人擁有醫院病床數: 49 人均醫療支出(美元): 503 衛生開支占國內生產總值的百分比: 11.8 愛滋病毒感染百分比: 0.052
  4. 4. 你所不知道的古巴台灣僅存的印象:雪茄、棒球、切˙格瓦拉★對外醫療★古巴的醫學教育-拉美醫學院★社區醫療與家庭醫師★替代療法
  5. 5. 古巴的對外醫療1. 1963年,古巴援助阿爾及利亞醫療 -古巴公衛部長說,「這很像是乞丐助人,但我們知道, 阿爾及利亞人比我們還更加需要,他們也應該得到這樣 的協助。」2. 21世紀: 【醫療視為商品】用以診治前來哈瓦那問病的人 俗稱「醫療觀光」,以西方人士為主,以此賺取外匯 【延續了古巴立國以來的國際主義襟懷與實踐】 (a) 為比較貧窮的國家,培訓醫生(拉美醫學院) (b)海外醫療
  6. 6. 拉美醫學院 為比較貧窮的國家,培訓醫生 1998年創設 2007年初,它有一萬名醫科學生(六年制),規模是美國最大 醫科養成機構的十倍 這所醫學院只招收外國學生,大多數來自拉丁美洲,但也有91位 中低階層的美國人,所有學生就學期間的食宿與學費全免。 繼續提供海外醫療
  7. 7. 古巴的海外醫療 古巴醫生來到保健相對落後的地區,為其住民提供醫療服務(比如,至南非協助愛滋病患) 這項服務也有平時與非常時期兩種。 【平時】In Venezuela:有1.5萬位醫生與牙醫 【非常時期】2005/10/25 - 巴基斯坦發生大地震, 古巴有2500位醫療人員持援 他們與災區的人生活在相同條件,如:住在帳棚,不是住在飯店 古巴每萬人平均醫生人數是美國的2.5倍,因此禁得起長年有三分之一醫生在在海外工作古巴文化部長:「我們的醫生去幫助他國,使命是醫護,但也承載我們的價值觀和我們的團結思想」。。
  8. 8. Community-Oriented Primary Care(COPC) National health institute and hospital center (quaternary care-super specialty) Provincial hospitals (tertiary care-high specialty) Municipal hospitals (secondary care-specialty) Area health centers (primary or community care, 25,000-30,000 people) policlinicos (specialty clinics, 4000-5000 people) consultorio.(primary care clinic, 600-700 people)
  9. 9. Community-Oriented Primary Care(COPC) Family physicians, paired with nurses 600 patients or 150 families Health promotion and disease prevention 早上看診,下午居家訪視(急症、慢性病)
  10. 10. Medical Records All records are organized by families, districts  Simple, handwritten Divide people into groups according to their risk of being unhealthy  Smokers: category II  Stable, chronic lung disease: category III
  11. 11. Complementary and AlternativeMedicine (CAM) Not necessary to focus on expensive technology as the initial approach to medical care. Students spend 200 hours in the first 2 years of medical school on CAM acupuncture, herbal medicine, trigger point injections , massage, heat therapy, transcutaneous electrical nerve stimulation
  12. 12. The Challenge of Cuba’s health caresystem? Export of domestic medical resources  Medical equipment, medicine  Doctors Privatization of Medicine  The rising fee of medical education Resource management  Technology dependence  Training alignation
  13. 13. Export of medicine? Due to 50 years trade embargoes from the USA, Cubans export whatever they can to earn money  In medical resources, $6 billion/year The disparity between domestic and international medical supply Physicians ‘against all odds’
  14. 14. Export of MD? Education: free  Obligation to serve in Cuban government Sent abroad as the ‘token’ of diplomacy Salary: $20 /mo  USA: $138000 /y  What would you choose? Pressure on domestic MDs
  15. 15. Privatization of medicine World-acclaimed medical achievements  Medical tourism  Doctors frankly sell their service Both two best hospitals of Havana: Cira Garcia and CIMEX, run for benefit  Big gap between these institutions and public hospitals Medical inequity?
  16. 16. The rising fee of medical education
  17. 17. Huge amount of health care provider? High doctor-patient ratio  How to maintain quality without the dependency of technology?  Rely on MD’s clinical skill Government controlled medical education  Meet the country’s need  Increase availability for more equal distribution
  18. 18. Conclusion What can we learn from Cuba?  Facilitate community-oriented primary health care  Free (or cheap) medical education  Health as an necessity good, health care as a welfare  Treat our MDs better XD  Communism XDD
  19. 19. Reference big-business-cuba-nip-and-tuck
  20. 20.  lessons/ system-at-a-crossroads/
  21. 21. That’s it!!!