Health system in Cuba praised

Baltimore experts tour nation's hospitals

May 15, 1999|By Scott Shane | Scott Shane,SUN STAFF

It's not enough that Cuba trounced the Orioles on the baseball field. Now a delegation of Baltimore health experts has returned from a three-day tour praising the Cuban health system, saying that the Communist nation has achieved better measures of public health than Baltimore for much less money.

"For a country that's basically quite poor, their health statistics are tremendous," Dr. Peter L. Beilenson, Baltimore's health commissioner and leader of the delegation, said after the group returned from Cuba Thursday. "And they do it with a tiny percentage of the resources we have."

Beilenson organized the exchange after the Orioles and a Cuban all-star baseball team played in Havana and Baltimore this spring. A group of Cuban doctors and other health professionals will visit Baltimore in August.

The eight American visitors, who included former Maryland Health Secretary Nelson J. Sabatini and Dr. George J. Dover, director of the Johns Hopkins Children's Center, saw deteriorating conditions in hospitals, where a failing socialist economy and crippling U.S. trade embargo have created severe shortages of supplies. Waits are long for surgery and other specialized procedures, if they are available at all.

They heard about some coercive health policies of President Fidel Castro's government, such as a requirement that pregnant women not caring properly for themselves be moved to group homes until their babies are born. They were subjected to "political diatribes" by Cuban officials, said Dr. Stephen T. Bartlett, a University of Maryland transplant surgeon.

But the Baltimore health experts said Cuba nonetheless has things to teach the United States: the importance of universal access to health care and the value of prevention. Cuba's emphasis on those basics has produced a far lower infant mortality rate and a higher immunization rate than Baltimore's.

"I went in as skeptical as anyone," Dover said. "I left there very impressed with what the Cuban government has accomplished."

The Cuban tour comes as a group of Maryland health advocates, led by Beilenson, is launching a campaign for guaranteed health coverage for all state residents.

Known as the Maryland Citizens' Health Initiative, the coalition has raised $500,000 and recruited as executive director Vincent DeMarco, a veteran grass-roots organizer and lobbyist who previously headed campaigns for gun control and an increase in the tobacco tax.

The group will push for state legislation to create a "single-payer" system, like that in Canada and many other countries, in which a single health plan replaces the existing array of government and private insurance coverage.

"We know the overwhelming majority of Marylanders want everyone to have health coverage," DeMarco told about 100 members of the coalition yesterday at the headquarters of the state medical society.

The effort is likely to face ferocious opposition from the health insurance industry. But Beilenson said the fact that the powerful state doctors' organization would lend its premises for the meeting is evidence of physicians' dissatisfaction with the current system, particularly the excesses of managed care.

Americans spend a colossal amount on medical care, yet an estimated 46 million people lack health insurance. Spending is concentrated on costly, high-technology medical procedures rather than on basics such as prenatal care.

Meanwhile, despite the economic devastation caused by the embargo against Cuba and the end of trade and subsidies from the Soviet Union, Cuba's basic health statistics have remained strong.

Cuba's infant mortality rate is 7.1 per 1,000 live births, a little higher than the U.S. rate of about six per 1,000. But despite a recent decline, Baltimore's rate of 11.6 is far higher than Cuba's.

A crash program to make sure Baltimore 2-year-olds get vaccines has increased the city's immunization rate to 84 percent, but that is far below Cuba's rate of more than 95 percent, Beilenson said.

Life expectancy in Cuba, about 76 years in 1997, is roughly equal to the U.S. average and far better than Baltimore's, about 68 years in 1997.

The American visitors said the centerpiece of Cuban health care is a well-developed system of neighborhood physicians. Each doctor is assigned about 120 families and given a house in the neighborhood with medical offices on the ground floor for the doctor and a nurse.

"In the morning, they see patients in the office. In the afternoon, they walk the neighborhood and visit people in their homes," said Dr. Javier Nieta, a physician and epidemiologist at the Johns Hopkins School of Public Health. A member of the delegation, Nieta has studied and worked in Cuba.

For the seriously ill, the shortage-afflicted Cuban system is not so impressive. At American rates, said Bartlett, the transplant surgeon, one would expect about 250 kidney transplants a year in Cuba's population of 11 million. Cuban doctors are performing 15 to 25, he said.

Pub Date: 5/15/99

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