Teaching physicians global healthcare in Cuba

As with most lessons in business, understanding global healthcare is best done on the front lines. That’s the goal behind the Global Healthcare Experience course offered in the Kelley Business of Medicine Physician MBA program.

Thirty physician students in the healthcare elective course recently traveled to Cuba to learn how the country delivers public healthcare.

“From an academic or executive perspective, there’s really no substitute for first-hand experience,” said Sasha Fedorikhin, associate professor of marketing at Kelley. “In class, we can talk about the Cuban healthcare system and prepare students for experiencing it with assigned readings, but there are certain things you cannot appreciate without being there and actually seeing it.”

The program provides a list of academically vetted countries, which the students vote on during their first year in the program. Students select which country they’ll study and eventually visit during the six-week course offered in their second year. The countries are selected based on their unique healthcare perspectives and high contrast with the U.S. system. The current second-year class elected to spend the week in Havana, hearing lectures from Cuban healthcare providers, touring the city and visiting clinics, medical schools and public health centers. Physicians had the opportunity to examine both the business opportunities and the healthcare delivery models of the Cuban system.

“It would be difficult to find a system more different from our own than Cuba’s, and a number of students caught on quickly to that contrast,” says Fedorikhin.

“This experience stretched their thinking and helped them consider healthcare from different perspectives. They may not use all the lessons they learned there in their practices back home, but a lot of concepts are worth considering.”

One of the starkest contrasts between the two systems – and arguably where the prime learning opportunity lies – is within each country’s philosophical approach to healthcare.

“Cubans view access to healthcare as one of their basic rights. The emphasis is on the ‘health’ part of it, with a heavy focus on prevention and education,” explained Fedorikhin. “On the other hand, here in the United States, it’s a focus on the ‘care’ part of it and treating the sick. Cuba does not have a lot of the advanced technology available to U.S. healthcare providers. Both sides would benefit from cooperation and have a few things to learn from each other.”

While the Cubans don’t have the sophisticated technology available in the United States, they often expressed during the trip that their most important piece of medical equipment isn’t computerized or robotic: It’s the chair they use while visiting with patients.

“Cuba achieves several important healthcare benchmarks that are at the same level or higher than those here in the U.S. while spending a fraction of money, and on quite limited resources,” said Fedorikhin.

For instance, the infant mortality and life expectancy rates in Cuba meet or exceed those of the United States, according to the World Health Organization. Giving students an up-close view of the differences between the two healthcare delivery models provided a unique opportunity to not only re-examine the healthcare system in which they operate, but to consider how different approaches can form such distinct care structures.

Cubans think of healthcare the way we think of public education.

Kyle Anderson, clinical assistant professor of business economics

“We produce a lot of teachers in the United States, we put them out in elementary schools all over to educate our children. That’s their model for healthcare," added Kyle Anderson, a clinical assistant professor of business economics at Kelley who joined the trip to gather research. "They train a majority of primary care physicians, instead of specialty surgeons, and then place them in various neighborhoods where they are assigned a group of families to treat.”

They are expected to live in that community and provide house calls when needed, he explained.

“It’s a very different model of primary care, but in some ways it’s very comforting that essentially every Cuban has a physician who’s responsible for taking care of them,” said Anderson.

Cuba’s focus on primary care is coupled with aggressive awareness campaigns in a population that has a nearly 100 percent literacy rate.

In Cuba, it’s about prevention, promotion and education.

Sasha Fedorikhin, associate professor of marketing

“About 75-80 percent of all issues are resolved at the primary care level, which saves a lot of money for the system," added Fedorikhin.

Kelley Physician MBA students also learned about the burgeoning healthcare business opportunities in Cuba. For example, the biotech and pharmaceutical industries in Cuba create some high-level medications that are unavailable in the United States, and these opportunities are growing as the country continues to open its borders.

“Cubans are very entrepreneurial and the government has allowed a lot of privatized companies,” said Fedorikhin. “It’s estimated that about a quarter of the workforce is now in the private sector in Cuba.”

While the inquisitive group of physicians was able to ask questions and hold conversations with healthcare experts in Cuba, a number of places in the communist country were off limits to the tour.

However, Fedorikhin says things are changing a little more each day. A clinic that had previously prohibited photography during an October visit allowed pictures during this trip.

“It was the first time they allowed photography in this clinic so things are changing and opening up, but very slowly and gradually,” said Fedorikhin.

“We hope to go to Cuba again in the future because it provides a great location and varied learning experience for the students. We expect that with every new visit, we will be able to see more and more of this unique healthcare system.”