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Charging for care would be a dramatic and unlikely about-face, but with 15 percent of the budget devoted to health, Havana sees no choice but to make the system more efficient wherever it can.
After steadily rising over five decades to hit $206 million in 2009, health spending has dropped, slipping to $190 million last year, according to government figures. Officials hint at more cuts to come.
Cuba vs. U.S. health costs
What Cuba says it spends on medical services is a fraction of what it costs hospitals to provide the same services in the United States. A comparison of some medical procedures in the two countries:
Cost per day for inpatient hospital stay: $5.49 in Cuba; $1,994 in the U.S.
Inpatient hernia surgery: $14.59 in Cuba; $12,489 in the U.S.
Hip-fracture repair: $72.15 in Cuba; $14,263 in the U.S.
Kidney transplant: $4,902 in Cuba; $48,758 in the U.S.
Cuban authorities did not reveal how they calculated their figures, but said careful study was involved.
While some medical goods are imported, Cuba produces many medicines and labor costs are significantly lower than in the United States, with one doctor saying Cuban specialists earn $25 a month.
Cuban patients also often bring their own sterile bed sheets, hypodermic needles, food and water.
These days, authorities rail against "irrational expenses" and have slashed more than 50,000 less-skilled health-sector jobs, singling out overstaffed clinics and ambulances with multiple drivers.
Some Cubans say hospital wait times seem to be on the rise and medicine, equipment and soap are increasingly in short supply.
The clinical doctor consulted by the AP said neither scarcity nor complaints have worsened, though doctors still suffer heavy case loads and low pay, about $25 a month.
Cuba is walking a delicate line on health: Too much change could be seen in some camps as a betrayal of the socialist contract. Too little may not ease the burden on a strained economy, said Sergio Diaz-Briquets, a U.S.-based demographer and author of "The Health Revolution in Cuba.
"It is maybe a universal phenomenon that health care systems are expensive," he said, "but Cuba perhaps cannot afford to have the kind of services that they claim to have had in the past."
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