Healthcare

System: Cuba and China 1

De La Salle-College of Saint Benilde

2544, Taft Ave., Manila, Philippines

A Comparative Analysis on the Healthcare Systems of China and Cuba: Treatment of

Cancer Patients

A partial requirement in Comparative Government, Second Term, SY 2009-2010

Submitted to:

Prof. George R. Binay

Submitted by:

Dy, Jayson V.

Peñaranda, Jellie Ann M.

Ramos, Sixteen R.

Date:

October 30, 2009

 Healthcare
System: Cuba and China 2

Table of Contents

Part I: The Problem

Research Problem
Healthcare systems around the world vary as applied to different countries. The degree of
effectiveness qualified through responsiveness, coverage, and overall welfare after treatment is
an important factor taken into consideration in the assessment of healthcare systems. However, it
is also important to note that healthcare treatment may also vary depending on the nature of
illness that a patient has, hence the priority of responsiveness, and also coverage, might have
different outcomes. Therefore, for the purpose of this comparative analysis, the authors have
narrowed down the study into the context of treatment of cancer patients.
Considering the scope of this analysis, the authors would be addressing the following
problem statement as this research progresses: How are the healthcare systems of China and
Cuba distinct from one another in terms of cancer treatment?
The authors chose to analyze healthcare situations in the defined context of cancer
treatment. Therefore this comparative analysis employs the theme: A Comparative Analysis on
the Healthcare Systems of China and Cuba: Treatment of Cancer Patients.

Introduction
The government, in order to uphold the success and welfare of the country as a whole,
must provide its citizens with the essentials they need – essentials that are beyond the basic needs
 Healthcare
System: Cuba and China 3

of people; those of which ensure protection, health, and security. The most important of these
essentials is healthcare. Healthcare systems are designed to provide the health needs of target
populations. However, because of the existence of various models of healthcare systems,
arguments arise on the effectiveness of the delivery of these systems. The issue on the quality of
healthcare is further deepened in the situations of developing countries where questions on
disease prevalence and control confront state leaders. This, added to the consideration of a
universal, or a market-based healthcare system makes it a tricky and complex problem to reflect
upon. In this comparative analysis, the healthcare systems of the People’s Republic of China and
the Republic of Cuba will be studied with a number of variables on healthcare that would allow
for a clear distinction of the nature of each system and of the challenges these systems encounter.
 Healthcare
System: Cuba and China 4

Review of Related Literature

HEALTHCARE IN DEVELOPING COUNTRIES: CANCER SURVEILLANCE AND

CONTROL
On a symposium article written by P. Kanavos (2006), China, along with India and some
Latin American countries were mentioned as having cases of prevalent cancer. It was stated in
the same article that the trend of increased cancer risk, be it environmental or disease-related
cancer in developing countries is a manifestation of policy deficiencies. Kanavos points out the
deficiencies as the lack of effective cancer surveillance and control, but, more fundamentally, the
lack of adequate healthcare, funding and coverage at the national level, as well as the lack of
effective preventive policies. The gravity of cancer prevalence was emphasized by Kanavos,
stating that 60% of the 58 million annual worldwide deaths estimated for 2005 are caused by
cancer, cardiovascular disease, and chronic respiratory diseases. Moreover, more than three-
quarters of these deaths occurred in developing countries.
Kanavos emphasizes on two needed advancements: cancer surveillance and cancer
control systems. Surveillance of cancer is critical to the implementation of evaluation of primary
and secondary prevention programs while survival data are an essential measure of outcomes,
Kanavos elaborates. He also says that one of the starkest global disparities in cancer control is
the lack of mechanisms for data collection. Although international efforts on data gathering
about cancer incidence are important, the quality and validity of these information depends
largely on local surveillance, which vary significantly across regions.
Some cancers amenable to early detection and treatment, such as testicular cancer, oral
cancer, and cervical cancer continue to have a high incidence and mortality in less developed
countries mainly because screening programs and pathologic expertise for rapid and accurate
diagnosing and staging are lacking, according to Kanavos. Surprisingly so, he adds that the
availability of radiotherapy services falls short of need, even in countries with the best healthcare
infrastructure. Kanavos expounds more importantly on the lack of training, suboptimal
utilization of radiotherapy resources, deficiencies in quality assurance, and a need for greater use
of evidence-based treatment guidelines, as current obstacles to optimal cancer management.
Another obstacle that Kanavos points out in the article was that there is a lack of adequate
healthcare coverage available to many persons in less developed countries, and when available, it
is often inequitable and not affordable. He adds that in low income countries, health spending per
capita consistently ranks among the lowest globally. Kanavos expounds that the 2005 Human
Development Report from the UNDP revealed that countries with progressively lower income
and health spending per capita also have proportionately higher burden of disease and lower life
expectancy. However, in many middle income countries, there are promising new initiatives.
China is an example of this, with ongoing policy reform initiatives both in urban and rural areas
that have resulted in nearly 120 million people being able to access health services through
medical savings accounts (Kanavos, 2006).
 Healthcare
System: Cuba and China 5

GENERAL STRUCTURE OF THE HEALTHCARE SYSTEM

Health Plans and Policies

In report to the People’s Congress in 2006, China Prime Minister Wen Jiabao noted three
national health priorities for the Government (WHO Regional Office for the Western Pacific,
2006):

1. Strengthen the public health system. Within three years, the Government will try to
establish fully functioning disease prevention and control system and an emergency
medical aid system that covers both the urban and rural areas. The Government hopes
that these systems would enhance the country’s capacity to deal with major epidemics
and other public health emergencies. In the coming years, the Government will pay
special attention to SARS, HIV/AIDS, tuberculosis, schistosomiasis and other major
communicable diseases.
2. Improve health services in rural areas and continue pilot projects of the new rural
cooperative medical system. The Government will increase the investment in rural
areas to update the basic health care facilities and train rural health workers. The
Government will also press ahead with the pilot projects for the new rural cooperative
medical system. The Government’s goal is to establish a rural health care system
based on voluntary participation of rural farmers and financial contributions from
individuals, collectives and the Government.
3. Reform the urban health care financing health delivery system. The Government will
continue the reform of the basic medical insurance system for urban employees, the
health service delivery system and the pharmaceutical production and distribution
system. Special attention will be given to the rational distribution and efficient
utilization of health care resources and the improvement of community-based health
care services.

Whereas these plans of China are more oriented towards improving the geographical
coverage of healthcare extending to the rural areas, Cuba’s strategies and priorities are focused
more on the enhancement of medical technology and research rather than in the geographical
aspect of coverage.
Taken from a 2001 report by the World Health Organization, Cuba adopts such national
health policies as follows:

In 1991, the Ministry of Public Health drafted a document entitled Objetivos,

propósitos y directrices para incrementar la salud de la población cubana 1992–2000
["Objectives, Aims, and Guidelines for Improving the Health of the Cuban Population
1992–2000"], which defines health goals and objectives to be achieved by the year
2000. In 1996 five strategies and four priority programs were identified. The
strategies include:

1. Reorientation of the health system toward primary care and the family doctor and
nurse program, which is considered the pillar of the system;
 Healthcare
System: Cuba and China 6

2. Revitalization of hospital care;

3. Revitalization of high-technology programs and research institutions;
4. Development of a program on natural and traditional medicine and remedies, and
5. Care with an emphasis on system objectives, such as dentistry, optical services,
and health transport.

The priority programs are those on:

1. Maternal and child health

2. Chronic noncommunicable diseases
3. Communicable diseases, and
4. Care of the elderly.

However unique the approaches might be, Cuba and China have the same motivations.
The Ministry of Public Health of Cuba has developed a strategy for responding to existing,
emerging, and reemerging health-related problems, as China’s government and other partners in
health have realized the importance and urgency to address some of the key health issues as well,
and will work together towards establishing an efficient and equitable health care system in the
country (WHO Regional Office for the Western Pacific, 2006).

The Health System

In Cuba, the State assumes full responsibility for the health care of its citizens. Accordin
to the WHO profile report on Cuba (2001), in 1983 the Parliament adopted the Public Health
Law, which lays out the general activities to be carried out by the State to protect the health of
Cuban citizens. This law, according to the Report, establishes the organization of the sector and
the services to be provided by the State. The National Health System is organized at three levels
(national, provincial, and municipal), which mirror the country’s administrative structure, headed
by a government representative at each level (WHO Profile Report, 2001).

As stated in the Report, the process of decentralization and the creation of a new structure
of government that allows for more grassroots involvement (through the popular councils) has
encouraged active participation of the social sectors in health management at the local level.
WHO reported that this has facilitated intersectoral collaboration and have increased the capacity
for social participation in the identification and solution of health problems in the community.
The "health initiative" process is aimed at mobilizing national and international resources to
support reform and modernization of the sector (WHO Profile Report, 2001).

After the 1959 revolution in Cuba, the government developed a free and accessible public
health care system that has been central to Cuba's vision of an egalitarian society (Andaya,
2009). A key node in the system has been the network of family doctors who live in the
communities they serve, Andaya notes in her 2009 article on Cuba’s Socialized healthcare. She
further states that this both allows patients continual access to health care and gives doctors an
intimate knowledge of individual, familial, and neighborhood risk profiles. Andaya elaborates
that while the medical budgets of many developed countries reflect their emphasis on costly
 Healthcare
System: Cuba and China 7

curative medicine, Cuba achieves comparable health indices with a fraction of the cost by
focusing on community-based preventative care.

China shares the same ideals of modernization of the health sector and social
participation / collaboration for its healthcare system, visible in their plans. In 2009, the National
Development Reform Commission and the Ministry of Health announced their national health
reform blueprint.

The main objective is to provide universal coverage of basic health care by the end of
2020. Reforms are proposed in five areas: the public health system, the medical care delivery
system, the health security system, the pharmaceutical system, and pilot hospital reform. The
initial three-year implementation plan for 2009-2011 emphasizes several programs on improving
the social health security system (urban employees, urban residents, rural CMS, and medical
assistance programs); establishing an essential medicines system; strengthening primary-level
health care facilities; reducing disparities in public health care between regions; and piloting
reforms in public hospital financing by reducing the reliance on drug sales for operational costs
and salaries WHO Regional Office for the Western Pacific, 2009).

China’s healthcare blueprint is unique in a sense that it features a thorough organization

of particular systems within the healthcare system as a whole. Cuba, on the other hand has a
distinct feature in the aspect of social participation, through mobilization of international medical
missions. Since the first Cuban medical mission in 1963 (to Algeria), more than 100,000 of the
country's health professionals have served in 103 countries (Andaya, 2009). In 2005, for
example, some 20,000 of them about one quarter of Cuba's health personnel - were serving in
Venezuela, Andaya says. This allows Cubans to earn extra money without abandoning their
profession or permanently leaving their country - as occurs in the brain drain faced by many
developing countries.

CHALLENGES TO THE HEALTHCARE SYSTEM

In the case of Cuba as reported by WHO (2001), despite the development attained by the
health sector in recent years, the Public Health Law needs to adapt to new factors and
determinants, which have modified the public health environment, both internally and externally.
Since 1995, the Health Commission of the Cuban Parliament, in conjunction with the Ministry of
Public Health, has been in the process of revising the existing legislation (WHO, 2001)
This challenged adaptability of Cuban health policies is quite different from what
challenges China is experiencing. The existing health service system in China is characterized
with excessive usage fees. It is largely a system of private financing and public provision, with
public expenditures left to fill the gaps, provide employment-based social health insurance and
address shortfalls in public health services. In the past 20 years, an over-reliance on household
payments to finance health care operating costs has led to increasing inequities in access to
health services (WHO Regional Office for the Western Pacific (2006).
 Healthcare
System: Cuba and China 8

Cancer Surveillance
As cited by Thompson (2009), according to recent MOH statistics, cancer is one of the
three leading causes of death in China, and it is one of the key determinants of the growing
demand for health care. In Fang (2006) study, the author noted that the highest mortality of
cancer is to be found in Shanghai city, with the highest mortality rate, and Jiangsu, Fujian,
Zhejiang province. The rising cancer mortality rate was more marked in the countryside than in
the cities. Moreover, high-incidence areas tend to not only be rural but also located in the
western part of the country (WHO, 2003). This condition of cancer prevalence is very much
similar to Cuba. Since 1958 cancer has been the second cause of death in Cuba, after
cardiovascular diseases, with 20,000 to 25,000 new cases annually, and 13,000 to 15,000
thousand deaths a year, according to the review of the Medical Education Cooperation with Cuba
(MEDICC) in 2003.
The World Health Organization’s Preventing chronic diseases: a vital investment in 2005
cited that China’s Ministry of Health, with the support of WHO and the cooperation of relevant
sectors, has been developing a national plan for chronic disease prevention and control, which
focuses on cardiovascular diseases, cancer, chronic obstructive pulmonary disease and diabetes.
Programme of Cancer Prevention and Control in China (2004–2010) was developed by
the Ministry of Health to reduce the overall level of risk factors, to improve early
detection and treatment and to provide accessible and affordable health services. It
includes the development of a national system of prevention and control, which will
require comprehensive financing, multi-sectoral cooperation and the establishment of
expert committees at the national and local levels. It will also involve capacity building
and the establishment of a national surveillance system, as well as periodic surveys of
nutrition and health (WHO, 2005, p. 129).
Such a program is another similarity in the processes of cancer surveillance in Cuba.
Since the 1960s, the Ministry of Public Health has made efforts to control cancer, and in 1986,
established the National Cancer Control Program (NCCP), also following the experiences and
recommendations of the WHO (MEDICC, 2003). China and Cuba crafted their cancer
surveillance programs in the same pillars of early cancer detection, national integration of
institutions and organizations, with programs in specific cancer cases. The following, as
reviewed by the MEDICC, are the major developments under the NCCP:

The political priority placed on public health by the Cuban government.

The development of a health care system with broad coverage throughout the country.
The creation of a National Cancer Registry (NCR) in 1964.
The implementation of an Early Diagnosis Program for Cervical-Uterine Cancer,
beginning in 1969.
The establishment ofNational Treatment Guidelines (1978) and the incorporation of
Diagnosis Guidelines in 1981.
The implementation of the Early Detection Program for Mouth Cancer in 1983.
Computerization of the NCR in 1986.

Thus, in 1986, all activities carried out by institutions, individuals and organizations were
integrated in what was called the National Program to Reduce Cancer Mortality (MEDICC,
 Healthcare
System: Cuba and China 9

2003). In the MEDICC review, the program incorporated Breast Cancer Screening, including
mammography beginning in 1990, and pediatric oncology, distinct cases in which Cuba has
given full effort.

From 1999 to 2001, a chronic disease self-management program was developed in

Shanghai. The program included exercise, the use of cognitive symptom-management
techniques, nutrition, fatigue and sleep management, use of medications, management of fear,
anger, and depression, communication with health professionals, problem-solving and decision-
making. This significantly enhanced participants’ health behavior, confidence and health status,
and reduced the number of hospitalizations after six months. The program has been implemented
in 13 communities and six districts of Shanghai, and is being replicated in other cities (WHO,
2005).
As a distinction, although Cuba does not invest on self-management programs like China
has, its efforts are full on cancer research. Cuba takes data gathering on cancer prevalence very
seriously. This is evident in the journal article by Rodriguez et al (2008) on familial cancer,
Prevalence of BRCA1 and BRCA2 mutations in breast cancer patients from Cuba. The article
shows the research strategy done by scientists in Cuba: data gathering through conducting a
study of unselected breast cancer patients from Havana, obtaining family history of cancer from
each patient and a blood sample processing for DNA analysis, among other clinical tests.

Health Standards: Medicines and Medical Supplies

Delivery System
In 2009, on its Country Health Information Profiles, WHO Regional Office for the
Western Pacific noted that China’s regulations on public health and health care delivery systems
are underdeveloped and poorly enforced, and monitoring capacity is weak. Most health facilities
lack clinical governance systems, and important gaps exist in the regulatory system to ensure the
quality of care. As an example, hospital accreditation is not linked to comprehensive safety
records, and doctors and health institutions are not restricted in their engagement in commercial
incentive programs. Deficiencies in clinical quality have resulted from financial incentives in the
delivery system, lack of clinical treatment guidelines, inadequate government resource
allocation, weak regulation among service providers, and the low capacity of health care
personnel.
Also, safety standards and health regulations are inconsistent in their design and
enforcement across sectors and localities. Weaknesses in safety regulation and enforcement are
particularly apparent in rural areas, where township and village enterprises operate unregulated
and generate the majority of occupational diseases, disabilities and deaths (WHO Regional
Office for the Western Pacific, 2009).
Whereas China’s weakness is in the realm of policy implementation for healthcare,
Cuba’s challenge is in the technical aspect. Cuba faces challenges in the availability of technical
resources (equipment) which causes a problem for coverage in high risk groups for cancer.
Although an important standard for Cuba is its banking in the strength of its healthcare personnel
 Healthcare
System: Cuba and China 10

through a main thrust in training and education in coordination with government policies, as well
as planning of human and material (equipment, medicine, etc.) resources, guidelines and
protocols for diagnosis and treatment, and auditing as the only way of taking full advantage of
their economic resources and usage of their capabilities to the optimal level (MEDICC, 2003).

Medicines
WHO Regional Office for the Western Pacific (2009) noted that as the overwhelming
majority of the Chinese population seeks out traditional Chinese medicine (TCM) to address
their health problems, the Government promotes the development of a modern TCM industry, as
well as the integration of TCM into the national health care system and integrated training of
health care practitioners.
However, there are a number of challenges to consider for further developing TCM.
Unified and systematic regulations for assessing the safety and efficacy and ensuring the quality
of TCM products are lacking and there are no national TCM standards or guidelines for TCM
clinical trials. Evidenced-based TCM product testing and research are still needed. In view of the
vast differences in the qualifications of TCM practitioners, the quality of TCM education needs
to be strengthened and the management and supervision of TCM institutions need to be regulated
(WHO Regional Office for the Western Pacific, 2009).
Whereas China invests on modernizing their traditional medicine industry, Cuban
healthcare, according to a report by Tania Jenkins (2008), has experienced a unique fusion of
medical traditions, such that now biomedicine and complementary and alternative medicine not
only coexist in Cuban society but actively collude together to respond to the increasing demands
for health services in light of waning supplies of medication and medical supplies. Cuba’s
investment on research, accompanied by the recovery of their economy, has allowed the country
to introduce new drugs in cancer treatment (MEDICC, 2003).

Human Resources
In WHO Regional Office for the Western Pacific Report (2009), significant challenges in
improving human resources for health in China include improving the human resource strategy
for health development; increasing capacity and technical qualifications; distributing staff more
evenly nationwide; and creating a more rational balance among the different health care
professions.
As cited by Thompson (2009), in the 2003 Statistical Yearbook published by the MOH
showed that only 0.2 percent of the medical workers in the entire system have doctorate degree.
Thompson (2009) asserts that village and township health professionals generally have
inadequate education to provide basic health services. The lack of confidence in the quality of
service at the local levels creates inefficiencies such as higher cost and patient loads in higher
level hospitals as well as brain drain of qualified doctors in local levels.
 Healthcare
System: Cuba and China 11

Accordingly, the WHO Regional Office for the Western Pacific Report (2009) noted that
qualified staff are not well distributed across the country. Poor and rural areas have not been able
to attract and retain qualified medical staff. After economic reforms, many experienced health
professionals moved to hospitals in cities and areas with well-paying clinics. This posed an
enormous barrier to the health care services delivery in remote and rural regions.
Cuba, however, does not face the same challenge at all. On L. Wayne’s report on US-
Cuba relations, Rethinking U.S. Relations with Cuba, Washington Report on the Hemisphere
(2007), it was written that by 2002, revolutionary Cuba has had an increase in the number of
doctors from 6,286 to 67,079, with the physician-civilian ration improving from 1 doctor for
every 1,076 patients in 1958 (pre-Castro) to an extraordinary 1 for every 168. Another notable
insight was made by Roger Downer in his news article for the Irish Times in 2007, Should Irish
healthcare take Cuban lessons? In the article, Downer narrated that the Latin American School
of Medical Sciences in Havana is training more than 10,000 students from 27 countries to help
address the global shortage of physicians. With that, Downer thinks it is particularly interesting
to note that recruits to the medical school include students from poor, remote and marginalised
communities with an expectation that, upon graduation, they return to serve those communities.
 Healthcare
System: Cuba and China 12

Significance of the Study

The authors, upon consideration of the proposed paper, believe that this study is important to:
1. Provide a deep understanding on the comparison and distinction of healthcare systems in
China and Cuba.
2. Students of politics and health, for this paper provides insight on the political aspect of
the righteous act of providing the people their due care.
3. Medical practitioners, more importantly those specializing in cancer treatment, as this
research may provide the needed information for the advancement of their careers.
4. The Philippine Government as this comparative analysis will familiarize leaders on the
approaches on healthcare employed by China and Cuba, and assist on the consideration
of policies to adopt on healthcare through the outcomes of the healthcare systems
involved in the study.
5. To non-citizens of China and Cuba who may be considering going to these countries for
cancer cure, to provide them information about the state or nature of healthcare in these
countries.
6. The United Nations, as this paper may provide information on the research gap between
the qualities of healthcare as applied to developing countries or post-communist
countries, addressing the complexity and broadness of healthcare issues.
7. The citizens of China and Cuba to have academic insights from the students in the
Philippines on the valuable lessons and weaknesses of the healthcare systems as applied
in the local jurisdiction of the said countries.
 Healthcare
System: Cuba and China 13

Variables for Comparison

For this comparative analysis the following indicators will be used as variables to identify and
compare the effectiveness of healthcare system of Cuba and China in the treatment of cancer:

Structure of Health Care System. This refers to the organization and framework of health care
system and the type of schemes as indicated in the policies of the two states. It also covers:
a. Financial System. This refers to the financing mechanism of the state in its health
care system; where the two states get its fund in providing a universal health care
system to its citizens and how citizens or certain group of citizens contribute in this
fund. It also covers the budget allocation of the two states in health care and the
corresponding expenditures.

Health Care System Delivery. This refers to the distribution of health care service of states to
their citizens. It covers minor areas such as:
a. Concentration of Medical Services. This variable pertains to the area within the state
wherein the government focuses or prioritizes its health services. This is either in rural or
in urban area, ideally. The condition and efficiency of health care system will be based on
these two areas to identify existing similarities and/or differences.

b. Timeframe of Responsiveness. This variable pertains to the period of time government

health facilities of China and Cuba respond to the medical needs of a cancer patient,
particularly in chemotherapy and other related necessary treatment.

c. Equity of Response. This variable pertains to the fairness and impartiality of government
health facilities’ response to the medical needs of a cancer patient regardless of his/her
origin (rural and urban area/local or foreign) and social status.

Resources for Health Care System. This variable refers to the availability of necessary natural
and human resources (i.e. physicians, specialists, nurses, and assistants), facilities, as well as
commodities (medicines and medical technology) to satisfy the health needs of the people.
 Healthcare
System: Cuba and China 14

Scope and Limitation

This paper will study the health care system of the Republic of Cuba since the
administration of Fidel Castro in 1959 as compared with the People’s Republic of China from
the onset of 1980’s health care reform up to present. The researchers will focus on how the
efficiency of these health care systems responds to cancer treatment and life expectancy.

However, the application of this discussion is concentrated on the treatment of cancer in

Cuba and PRC alone. Other chronic diseases, medical treatments, and concerns other than cancer
will not be conferred. Also, concepts that will be discussed in support of the comparative
analysis will be restricted on the variables aforementioned.

One of the anticipated weaknesses of this study is that the sources of information for the
discussion of PRC will be more on secondary—books, journals, and the like, as primary sources
are limited in availability.
 Healthcare
System: Cuba and China 15

Part II: Methodology

The authors deemed it essential to expound the actual research methodologies that will be
utilized in the development of this paper.
This chapter deals with the research process, sources and instruments, and the chronology
of procedure that the author/s will use.

Procedure
1. Determine the main problem which branches out from the topic.
2. Do a research about the background of the problem.
3. Establish supplementary research with primary sources. Interviews are preferred
to this comparative analysis.
4. Conduct an interview with key informants.
5. Use secondary sources such as books and journals for additional research.
6. Integrate all results from research and build coherence.
7. Analyze and search for possible answers for the main problem.
8. Establish an answer to address the problem.

Primary Data Sources

The primary key informants for this paper will be the Cuban Ambassador in the Philippines, His
Excellency Jorge Rey Jimenez and Mr. Wang Jiaxin, Second Secretary, Economic and
Commercial Counselors Office.

Instruments
The researchers will conduct an open-ended interview questionnaire with reliable resource
persons knowledgeable on the health care system of Cuba and China. Also, the researchers will
gather data from secondary sources such as books, Internet, online books, foreign or local
studies, journals, etc.
 Healthcare
System: Cuba and China 16

Questionnaire
For the Chinese Embassy Ambassador/Representative:
1. What are the policies and initiatives of China governing the health care system of all
citizens?
2. What is the present structure of the Chinese health care system?
3. Which entity provides, manages, and funds the system?
4. What is the role of the state in the health care system?
5. How is the delivery of health care system in the country? What is the distribution of
health care services in the whole region and in the provinces of China?
6. How is the health care system funded? Where does it come from? How much budget
does the government allocate in the health care system?
7. How are the human resources of China for health adequate for the population in urban
and rural areas? What is the ratio of health workers to patients particularly in chronic
diseases like cancer?
8. How is the quality of health workers, physicians, and specialists especially in the rural
areas? What are the policies of the government requiring necessary training and
education for them to practice and give treatments to people?
9. How does the government implement the goal of universal health access given the wide
disparities in regions of China, particularly between the urban and the remote rural areas?
10. How is the threat of cancer addressed in the country? What are the preventive and
curative measures China provides to its citizens, if any? Are these measures on treatment
of cancer free and universal? Or is there just certain amount of subsidy provided by the
government? What are the subsidies, if any?
 Healthcare
System: Cuba and China 17

For the Cuban Embassy Ambassador/Representative:

1. What distinction does the present healthcare system have that makes it effective for the
government of the Republic of Cuba?
2. Is the Cuban healthcare system motivated by any international initiative on healthcare? If
so, what are these initiatives that influence the present system?
3. How does the present healthcare system qualify immediate cases for treatment?
4. In catering to cancer patients, what mechanisms does Cuba employ with regard to:
a. Coverage of treatment
b. Geographical concentration – are the urban areas being prioritized?
c. Immediateness of treatment (timeframe)
d. Treatment process (nature of tests / treatment)
5. How different are these treatment processes for the local Cuban citizens different from
that of the treatment given to tourists seeking health care?
6. In the report of the World Health Organization, it is stated that Cuba is confronted with a
lack of vaccines to cure health- and environmental-related illnesses. How does the
government cope with such problem?
7. What developments is the government prioritizing in the aspect of cancer treatment?
8. What reforms, if any, is the government planning to pursue with regard to the
organization of the health sector?
 Healthcare
System: Cuba and China 18

References

Andaya, E.. (2009). Cuba: Health Care as Social Justice. Review of ¡SALUD!. NACLA
Report on the Americas, 42(5), 42-44.

Blumenthal, D. & Hsiao, W (2005). Privatization and Its Discontents — The Evolving
Chinese Health Care System. The New England Journal of Medicine (pp. 1166-
1170). Retrieved on October 24, 2009 from
http://content.nejm.org/cgi/content/full/353/11/1165

Downer, R. (2007, February 13). Should Irish healthcare take Cuban lessons? Irish
Times,p. 4

Fang, Rukang (2006). The Study of Environment and Cancer in China. [PDF Document].
Retrieved on October 29, 2009 from: http://www.geographie.uni-
muenchen.de/geomed/pdf_presentations/07_Sat_Rukang.pdf

Helms, R. (2000). Health Care à la Karl Marx. American Enterprise Institute for Public
Policy Research. Retrieved October 24, 2009 from Columbia International Affairs
Online. Retrieved on: Oct 23, 2009 from
http://www.ciaonet.org/pbei/aei/oti/her01/index.html

Jenkins, T.. (2008). Patients, Practitioners, and Paradoxes: Responses to the Cuban Health
Crisis of the 1990s. Qualitative Health Research, 18(10), 1384

Kanavos, P. (2006)
The Rising Burden of Cancer in the Developing World. Annals of Oncology, 17
(Supplement 8): viii15–viii23, 2006
doi:10.1093/annonc/mdl983

Ma, S & Sood, N. (2008) A comparison of the health systems in China and India. Santa
Monica, CA: RAND Corporation Retrieved on October 24, 2009 from:
http://www.rand.org/pubs/occasional_papers/2008/RAND_OP212.pdf

Medical Education Cooperation with Cuba (2003)

Cuba’s National Cancer Control Program. Retreived on October 29, 2009 from
http://www.medicc.org/publications/medicc_review/V/23/pages/spotlighton.html.

Verran, S. (2009). Socialized healthcare with Chinese characteristics. Retrieved on October

24, 2009 from: http://en.chinaelections.org/newsinfo.asp?newsid=20310

Rodriguez, R., Esperon, A., Ropero, R., Rubio, M., Rodriguez, R., Ortiz, R., Anta, J., de los
Rios, M., Carnesolta, D., Del
 Healthcare
System: Cuba and China 19

Olivera, M., Vansam, S., Royer, R., Akbari, M., Donenberg, T., & Narod, S.. (2008).
Prevalence of BRCA1 and BRCA2 mutations in breast cancer patients from
Cuba. Familial Cancer, 7(3), 275-9.

Thompson, D. (2009) China’s Health Care Reform Redux. In Xiaoqing Lu, China’s
Capacity to Manage Infectious Diseases (pp. 57-78). [PDF Document] Retrieved
from: http://www.nixoncenter.org/Thompson-China-Health-Care-Reform-
Redux2009.pdf on October 24, 2009

UAE congratulates Cuba on impressive social development record. (2009, February 5).
Emirates News Agency (WAM)

Wayne, L. (2007) Rethinking U.S. Relations with Cuba. Washington Report on the
Hemisphere, 27(7/8), 9-11

World Health Organization (2001).

Country Profile: CUBA. Retrieved from: http://www.paho.org/english/sha/prflcub.htm
Retrieved on: Oct 23, 2009

World Health Organization (2005). Preventing chronic diseases: a vital investment: WHO
global report. [PDF File]. Retrieved on October 29, 2009 from:
http://www.who.int/chp/chronic_disease_report/full_report.pdf

WHO Regional Office for the Western Pacific (2006). Country health information profiles
(CHIPS) China. [PDF File]. Retrieved on October 29, 2009 from
http://www.wpro.who.int/NR/rdonlyres/84573E36-622B-411F-80B6-
590793599457/0/9_China.pdf

WHO Regional Office for the Western Pacific (2009). Country health information profiles
(CHIPS) China. [PDF File]. Retrieved on October 29, 2009 from:
http://www.wpro.who.int/NR/rdonlyres/E3A15481-80E2-400B-B801-
B52AC6F0C790/0/9finalCHNpro09.pdf