Cuba's delayed transition needs.
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Altruism↗
Biomedical subjects
Pol De Vos
Publications and source records attributed to Pol De Vos.
Cuba's international cooperative efforts in health.
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Cuba↗
Colombia and Cuba, contrasting models in Latin America's health sector reform.
Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful--and radical--example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign--especially North American--corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.
Colombia↗
Shifting the demand for emergency care in Cuba's health system.
Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995-2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients' expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.
Cuba↗
"No one left abandoned": Cuba's national health system since the 1959 revolution.
In spite of the economic hardships during the 1990s, Cuba has achieved health indicators that are among the best in the world. This article describes the development of the Cuban health system over more than four decades and analyzes its dynamics. Four stages can be identified. The system's foundations were laid during the first post-revolutionary decade (1959--1970) and consolidated during the succeeding decade (1970--1979). In the third stage, from 1980 onward, the system reached its full expansion with the development of family medicine. Following the crisis of the 1990s, a fourth stage began with reforms and adjustments to the new situation after the collapse of the Soviet Union. Today, health care continues to be of high quality and free for all Cubans. It remains exclusively in the hands of the public sector, and privatization is not an option. This is exactly the opposite of what is happening in other parts of the world where public services are underfunded and people are made to believe that privatization is the only way to ensure high-quality care.
Cuba↗
Unhealthy European health policy.
The European Union claims that the defense of its welfare state is one of today's most important challenges. This article analyzes whether the European governments and the European Union really pursue a policy that strengthens their health and social security systems, or one that is in itself a threat to health and social security. After a summary of the origin and evolution of the European health systems, the authors pinpoint underlying reasons for reform and demonstrate how, since the 1990s, the European Union has built a strict financial and political straitjacket, forcing these systems to carry out privatization and cutbacks. Reform measures can be divided into three interdependent categories: (1) the increasing influence of governments on health care organization, to enable restructuring; (2) measures aimed at reducing public expenses, including higher financial contributions by patients and restrictions on the range of services provided; and (3) measures that establish competition and hidden or open privatization of services and insurance systems. Through these mechanisms public expenses are reduced while private health care expenses (and private profits) rise freely. Ongoing European health care reforms thus struggle with the contradictions between responding to growing collective needs and securing or increasing private profits.
Delivery of Health Care↗