Reply #188: Thank you. Here are some decent stats, too:

[Judi Lynn]

Others are following the trend: Cuban model
Too much money could be worse than too little. For as long as they could afford it 'wealthy' countries stuck to an outdated and ineffective system. Pressure on budgets forced them to change direction.

The same happened in Cuba. Here harsh sanctions imposed by the USA on the island for over four decades brought the economy to its knees. Extravagant health spending was not an option. Allowing the health of Cubans to deteriorate was not an option either. Imaginative policies and practices had to be adopted. It goes without saying that old ideas, not unlike those advocated by Duncan and Newlands in Liverpool, and Lemuel Shattuck in Massachusetts, were picked up, dusted, and then put in practice. The results were spectacular.

Cuba's healthcare system, as with anything else to do with that country, is a minefield for anyone seeking reliable facts. However, one basic fact is now beyond dispute: Cuba has a first class health system achieved at a fraction of the cost associated with this level of success. A strong hint of the foundation for this success lies in the fact that Cuba has had a Ministry of Public Health since 1961.

One of the most detailed studies of Cuba's Social Services; including education, health, and sanitation, was completed in January 2002. It was commissioned by the World Bank as background for the World Development Report 2004, and undertaken by Dan Erikson, Annie Lord, and Peter Wolf. The report underlines the fact that "Monitoring the health data of the population plays an important role in the evaluation and shaping of health policy." (www.sld.cu) Comparison with the dearth of reliable information within the British NHS is instructive. A good picture of Cuba's state of health is included in the form of appendices to the report. Basically, life expectancy increased from 64 in 1960 to 76 in 2001. Infant mortality decreased in the same period from 60 to 6.2 per 1000 live births. Maternal mortality in 2001 was 33.9 deaths per 100,000 live births. (World Bank documents in www.worldbank.org )

Similar positive views were expressed in Summer 2002 in the Harvard Public Health Review. ( www.hsph.harvard.edu)

Cuba's health system evolved in the last four decades through three stages: the municipal polyclinic, the 'medicine in the community' programme, and then the 'family doctor-and-nurse teams' ( www.medicc.org). The latest stage provides 24 hour access to primary care through doctor-nurse teams. Each is responsible for only about 660-700 people to retain this focus without overburdening the doctors and nurses. The key unit in this system is taken as the family, and knowledge gained by primary care professionals about all members of the family is considered essential to the provision of a more effective service. The family doctor is involved in all aspects of healthcare: seamless progression from primary to tertiary care. The same seamless association is maintained between all services including social care.

Some space was given to healthcare in Cuba to illustrate the principle that effectiveness does not depend on funding alone. Much could be achieved at low cost once the right policies have been defined, implemented, monitored, and then modified sensibly.

http://www.globalcomplexity.org/Cost%20versus%20value.htm