Cuba to begin charging for medical service exports

As part of an overhaul to make Cuba’s healthcare system more efficient, the government is planning to charge for some of the medical services it provides abroad, AFP first reported.

Only countries that can afford it will have to pay for services, said a Public Health Ministry memo published Sunday on the official Infomed Website.

“The medical services will remain free for poor countries,” says the memo, titled “Transformaciones necesarias en el sistema de Salud Pública.” “But they will be sold to those whose economy allows it, with the goal to reduce our expenses and contribute to the development of the national health system.”

The island exports billions of dollars worth of medical services every year, as Cuban medicine has become a worldwide leader in healthcare services for people in poor and rural areas, as well as in disaster zones. At least 38,000 medical workers from Cuba are currently deployed in 77 countries, most of them in Venezuela. Started in 1998, the Escuela Latinoamericana de Medicina (ELAM) in Havana is currently training 7,200 students from all over the world and graduates some 1,500 doctors per year. Also, Cuba is in charge of a $700 million program to rebuild Haiti’s healthcare infrastructure, and more recently, Cuban doctors have played a central role in combating a cholera outbreak in that country.

ELAM campus in Havana


In a sign of Cuba’s increasingly pragmatic approach to exporting medical services, the Panamanian foreign minister announced during a visit to Cuba in November that his government will pay for the hands-on specialty training of Panamanian doctors in Cuban hospitals. The Central American country is building a public health infrastructure that includes five hospitals and 22 clinics, which require hundreds of doctors.

While Cuba has not charged recipient countries for medical services, some of the programs it provides in Africa, Asia and Latin America are funded by third countries such as Venezuela, Brazil, South Africa and Norway.

The only exception so far has been Venezuela, which, under a bilateral agreement, is paying at least $5 billion in oil and cash per year for the services of Cuban doctors and for training of Venezuelan and third-country medical students in Cuba. The Cuban contingent has been central to the development of the medical portion of Venezuela’s massive “Barrio Adentro” program.

Venezuela has also funded “Operación Milagro,” a billion-dollar program led by Cuba that has given free eye surgery to hundreds of thousands of low-income Latin Americans. Cuba has provided eye surgery on the island, but it has also built up and staffed Operación Milagro clinics in third countries such as Bolivia and Mexico.

Thanks mainly to cooperation with Venezuela, five years ago the revenues generated by Cuba’s service exports have surpassed those of tourism, nickel and sugar.

Cuba has proposed to the European Union and Canada that its doctors and medical services could be part of triangulated aid service provided in developing countries. So far, no agreement has materialized.

In India, Cuba set up a pilot project in the state of Kerala, a state with a history of Communist influence and the highest human development index in the country. The ambassador in New Delhi recently touted the good results achieved by the program, based on the Cuban neighborhood doctor and polyclinic model, and said that two years after starting in the capital city it is now expanding throughout the state. The model has been adapted to Kerala with some new ideas, such as the use of cell phone as databases and involvement of social workers in the administration.

The medical readjustment program in Cuba is part of broad cost-cutting efforts in the wake of a financial crisis. Of some 600,000 health workers in Cuba, up to 100,000 are dispensable according to health sources quoted by AFP. Health workers considered dispensable include nurses, technicians and administrators, but not doctors, Health Minister Roberto Morales said in October. Many of these health workers will be transferred to other activities; those who cannot be reassigned will be trained and sent abroad, according to the memo.

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