Family Practice in Cuba: Evolution into the 1990s

Abstract

A group of practising physicians, family practice academicians and medical students visited Cuba in 1991. The purpose of this visit was to assess the current status of the discipline of family medicine in the country. Numerous interviews were conducted with practising family physicians, Cuban medical physicians in other medical specialties, the medical school faculty, patients and officials from the Ministry of Public Health. A summary of the content of these interviews constitutes the following paper. The authors conclude that the Cubans have developed a medical care system that has its basis in family practice, and provides a model which could be emulated not only in less developed, but also in more developed countries.

Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine

“…Health care statistics from before the Cuban revolution in 1959, reveal a national profile common to impoverished Third World countries. 6,14 The current model of primary health care evolved from evaluations conducted since the 1960s. Identified deficits that led to the current model are similar to those facing US health care providers today: emphasis on curative rather than preventive services; lack of collaboration within the health system; fragmented care; patient discontent related to the inconsistent quality of care; excessive use of emergency rooms; and shortages of primary care physicians.…”

“…In the mornings, family physicians typically attend patients in their consultorio; "afternoons are reserved for home visits to patients with acute care needs, rehabilitation of chronic conditions, and primary prevention." 6 Patients requiring care beyond the scope of the consultorio are referred to a policlinico. Consisting of interdisciplinary teams, policlinicos offer specialty care in a variety of areas, usually including pediat- rics, internal medicine, nursing, social work, dentistry, and physical therapy, and sometimes including cardiology, pulmonology, ophthalmology, neurology, endocrinology, dermatology, and psychiatry.…”

“…Practically all graduates of medical school are currently required to complete a family practice residency. 6 Cuba has the highest family physician-topopulation ratio in the world, 11 and it has a family physician-per-patient ratio of approximately 1:600. 8 In the United States, the average family physician-per-population ratio is approximately 1:3200.…”

“…A number of studies describe and analyze the Cuban health system at a structural level 1,[5][6][7][8][9][10][11][12][13] ; no studies to date have focused on what family physicians can learn and apply at an individual level. Substantially changing the US health system at a structural level is a slow process at best and is virtually impossible for most family physicians.…”

Fifty Years of U.S. Embargo: Cuba's Health Outcomes and Lessons

“…Each of the country’s 498 polyclinics tailors medical services and education to the epidemiologic profile of their local population (30). Cuba added another primary-care level in 1984 by establishing neighborhood-based family medicine clinics, called consultorios (29, 31, 33). A polyclinic serves as the organizational hub for 20 to 40 consultorios.…”