In a sign of change for Cuba’s healthcare sector, a new for-profit medical services company bowed before an international business audience at the International Havana Fair earlier this month.
Empresa Comercializadora de Servicios Médicos de Cuba S.A., also known as Servimed, is a state company that bundles the 16 Cuban institutions that already provide more than 100 types of health services to foreign individuals on the island, ranging from cancer treatment and drug addiction programs, to dentistry and plastic surgery.
Servimed also coordinates the bigger-volume business of government-to-government services. According to company head Ismael Castillo, Servimed already provides for-pay medical services by Cuban personnel to governments of 15 countries.
For-pay medical services to other governments are not new. Panama, for instance, announced last year it will pay for the hands-on specialty training of Panamanian doctors in Cuban hospitals. The same year, Qatar agreed with Cuba to pay for an undisclosed number of Cuban physicians to serve at a recently-opened 54-bed hospital in the oil-rich country. Cuba also agreed last year to manage and staff eye surgery centers in hospitals in China and Algeria.
Servimed, according to Castillo, is providing services to 15 countries this year, including Algeria, China, Portugal, Jamaica, Qatar, Surinam and Ukraine.
Medical exports are already a billion-dollar reality for Cuba, but most of it is done under the mantle of solidarity. As Cuban medicine has become a worldwide leader in healthcare services for people in poor and rural areas as well as in disaster zones, at least 38,000 medical workers from Cuba are currently deployed in 77 countries. In what is probably the most ambitious program, Cuba is in charge of a $690 million plan to rebuild Haiti’s healthcare infrastructure. Also, started in 1998, the Escuela Latinoamericana de Medicina (ELAM) in Havana is training 7,200 students from all over the world, and graduates some 1,500 doctors per year.
Many of these programs are funded by Venezuela, and some by third countries such as South Africa, Brazil and Norway, but most are probably subsidized by Cuba. Cuba has proposed to the European Union and Canada that its doctors and medical services could be part of triangulated aid service provided in developing countries; so far, no agreement has materialized.
Thanks mostly to Venezuelan payments, healthcare service exports in 2004 surpassed tourism as Cuba’s main hard-currency generator. Under a bilateral agreement, Venezuela is paying at least $5 billion in oil and cash per year for the services of Cuban doctors and for training of Venezuelan and third-country medical students in Cuba. Venezuela has also funded “Operación Milagro,” a billion-dollar program led by Cuba that has given free eye surgery to hundreds of thousands of low-income Latin Americans.
Charging for medical services and international missions has been taboo in official discourse in Cuba. Not surprisingly, officials of the new company said that making Cuba’s public health services sustainable and more efficient was Servimed’s underlying mission. The revenues generated by Servimed, Castillo said, will be invested in maintenance, repair and purchase of equipment for Cuba’s public health institutions.
Servimed is spearheading a Cuban effort to increase for-profit medical exports outlined last year. A Public Health Ministry document published on the official Infomed Website in December 2010 said that, as part of an overhaul of Cuba’s healthcare system, medical institutions should begin to sell services to foreigners wherever possible.
“The medical services will remain free for poor countries,” said the document, titled “Transformaciones necesarias en el sistema de Salud Pública.” “But they will be sold to those whose economy allows it, with the goal of reducing our expenses and contributing to the development of the national health system.”
Cuba’s budget crunch since 2008 has shifted the attention back to domestic healthcare services. After a decade of exploding health spending — annual expenses mushroomed from 121 million pesos (CUP) in 2000 to 2.47 billion CUP in 2009, according to the National Office of Statistics (ONE) — the government is seeking ways to cut back expenses while maintaining service levels. After years of constant rises, the number of medical personnel on the island shrank by about 6,000 to 329,000 in 2009, from 335,000 the year before, according to ONE. Tens of thousands more health workers will be laid off, and many of them should be re-trained to work in for-profit programs and be sent abroad, the memo said.
