In my last article we discussed the basic structure of the health
care system in Cuba. We will now take a brief look at the secondary
level of care which involves hospitalization. This article will be brief
in nature due to the limited information shared with us regarding this
level of care. We also were not invited to tour an inpatient facility
either. In Cuba, it is felt to be the responsibility of the first
level’s responsibility to avoid hospital admission. We all know that
this cannot possibly be avoided 100% of the time.
If a patient’s condition warrants admission to the hospital, they are
transferred to the facility and care is passed to the inpatient
physicians at the admitting facility. The Family doctor unit is involved
on a consultation basis, to share important health and other
information with the treating physician. Specialists will be involved in
the care depending on the diagnosis of the patient. We were told the
family physician will visit the patient while in the hospital if
geographically possible. This is not to officially treat the patient but
to stay current on the condition and prepare for aftercare.
Upon discharge of the patient home, the family doctor unit will
receive a copy of the discharge summery for his files. At that time
coordination of care falls back into his responsibility. There are no
electronic health records in Cuba yet, but we were told that
statisticians do enter a large part of the patient’s record manually
into an electronic format. We did not physically see this operation, so I
cannot verify the validity of this claim.
It is important to note that the family doctor unit can be
scrutinized for having patients under his care be admitted to the
hospital. Officials will be looking for trends in a breakdown in the
primary care system allowing patients conditions to deteriorate to the
point of admission. This may or may not include reprimand to the family
physician. The same holds true for the inpatient side of the equation.
If a patient is discharged too early and is readmitted, the inpatient
physician in the secondary level of care can also be investigated for
proper care and discharge.
Cuban citizens do not have the right to file against a physician.
They can file complaints with the Ministry of Health to initiate an
investigation. Cuban citizens do have the right to visit any physician
they choose, but are encouraged to stay in the community in which they
live and are assigned.
Admission for the elderly is a family decision that is made
collectively with the family, family doctor and social worker team. This
will be on a case by case basis depending on the family’s ability to
care for the elderly family member. This again is encouraged to take
place in the home by the family.
Again, the data available regarding the secondary level of care was
minimal. We feel this may have been by design, but I have no evidence to
base this assumption.
Please feel free to comment or ask questions about this information I
am sharing. Also continue to follow these blogs as I share more about
the Cuban culture, Cuban food, and of course more about the Cuban health
care system. Next week I will be sharing about how you can attend
medical school in Cuba for free! There are currently 116 Americans
taking advantage of this medical school opportunity.