Does the Cuban healthcare system perform better than those of countries of similar economic strength?

Question

Cuba is frequently cited as an example of a country which has great healthcare considering its limited economic resources. For example:

• Salim Lamrani, Cuba's Health Care System: a Model for the World, Huffington Post:

According to the UN's World Health Organization, Cuba's health care system is an example for all countries of the world.

The Cuban health system is recognized worldwide for its excellence and its efficiency. Despite extremely limited resources and the dramatic impact caused by the economic sanctions imposed by the United States for more than half a century, Cuba has managed to guarantee access to care for all segments of the population and obtain results similar to those of the most developed nations.

The article goes on citing statistics of an infant mortality of 4.76/1000 and a health expectancy of 79.4 years.

• Lucia Newman, The truths and tales of Cuban healthcare, Al Jazeera:

Much of this praise is well-deserved. Despite its scarce resources, Cuba has one of the world's lowest infant mortality rates - just slightly lower than that of the US. Life expectancy is 77.5 years, one of the world's highest. And until not so long ago, there was one doctor for every 170 citizens - the highest patient-per-doctor ratio in the world.

Others, however, state that all is not as good as it seems:

• National Review, The Myth of Cuban Healthcare:

Then there is the real Cuban system, the one that ordinary people must use — and it is wretched. Testimony and documentation on the subject are vast. Hospitals and clinics are crumbling. Conditions are so unsanitary, patients may be better off at home, whatever home is. If they do have to go to the hospital, they must bring their own bedsheets, soap, towels, food, light bulbs — even toilet paper. And basic medications are scarce. In Sicko, even sophisticated medications are plentiful and cheap. In the real Cuba, finding an aspirin can be a chore. And an antibiotic will fetch a fortune on the black market.

(...)

In the Q&A, the kids spouted at him [Cuban exile Ermando Valladeres] the usual line about Cuba: health care, literacy, and blacks. They had been carefully taught it by their teachers. And Valladares answered, in essence, “It’s all untrue — a pack of lies. But even if it were true: Can’t a country have those things without dictatorship, without tyranny, without gulags, without torture — with freedom?”

It is difficult to reconcile the two. By objectively measurable indicators, such as access to (preventive) care, health expectancy, infant mortality etc., does Cuban healthcare perform better than the healthcare for countries of comparable economic strength? Or is there verifiable evidence that this is primarily a very well-constructed façade set up by the authorities in Cuba?

Answer 1

"Cuba has managed to guarantee access to care for all segments of the population"

This claim is true

It's even part of the constitution:

Article 50: Everyone has the right to health protection and care. The state guarantees this right; - by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; - by providing free dental care; - by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population cooperates in these activities and plans through the social and mass organizations.

"and obtain results similar to those of the most developed nations."

This claim is difficult to handle, it depends on what is your interpretation of "results".

Statistics of infant mortality and a health expectancy

Historically, Cuba has had good relations with UN dependencies like WHO or PNUD, and they usually cross-validate (at relatively small scale) the health-care statistics that the government provides, with their own representatives inside the country.

Examples of collaboration between WHO and Cuban health authorities:

1- Country-wide research on Optic Neuropathy Epidemy in the 90-ties.

2- Medical Education Cooperation with Cuba

3- Publications from MECC about Cuba and Health Care (Mix of Spanish and English)

"Hospitals and clinics are crumbling. Conditions are so unsanitary, patients may be better off at home, whatever home is."

This varies a lot from province to province or even from hospital to hospital within the same province. There is no 'one size fits all' when talking about sanitary conditions of hospitals and clinics in Cuba.

You can find things like this:

Hospital in Las Tunas

Source: http://medicablogs.diariomedico.com/jlrodriguez/2013/06/25/hospital-universitario-ernesto-guevara-de-la-serna/

Or like this:

Hospital in Havana (capital)

Source: https://www.cubanet.org/noticias/hospital-julio-trigo-abandonado-y-con-mosquitos/

Or this: https://panampost.com/belen-marty/2015/10/06/inside-the-cuban-hospitals-that-castro-doesnt-want-tourists-to-see/

"And basic medications are scarce. (...) In the real Cuba, finding an aspirin can be a chore. And an antibiotic will fetch a fortune on the black market."

It is not true that finding an aspirin is ALWAYS problematic. The problem in this case is that supply for ANY imported products in Cuba is unstable, including medication or raw materials for their fabrication. Aspirins may disappear from the market for a while, and the same can happen with soap, detergent, rice, toilet paper, gas, you name it. So the problem in this case is not the health care system per se.

Examples:

Cuban Government Explains Shortages of 25 Basic Products

Cuba Is Trying Price Controls To Deal With Food Shortages

Cuba's Tourism Boom Is Causing Food Shortages

Facing fuel shortage in Cuba, Havana diplomats roll up sleeves

Interesting facts:

Cuba's health expenditure per capita is at least twice as much as other countries in the region like Mexico, Argentina or Brasil, who have stronger economies by far.

Many developed countries with a single-payer system (like Canada or Spain), have limitations in the types of care covered, for example not covering dental care or eye care. The Cuban system covers both (see also Article 50 of the constitution), albeit with many deficiencies in terms of supplies.