Claim: Some Cubans choose dose of private medicine despite price.
Verdict: SUPPORTS

Retrieved passages:
title: Healthcare in Cuba
text: supervise and evaluate the neighborhood and clinical health work of the family medicine offices. While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. Like the rest of

title: Healthcare in Cuba
text: Privatization of healthcare in Cuba is illegal and unnecessary as high quality, equal, care covered by the state is available to everyone as made necessary by Cuba's constitution. Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccinations. This helped eradicate many contagious diseases including polio, tetanus, diphtheria and rubella, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis, hepatitis and chicken

title: Healthcare in Cuba
text: such as aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays. The Cuban government blames the shortages on the embargo and states that those with more severe chronic diseases receive medicines. However, other sources suggest that those with such diseases lack medicines. It is also suggested that in some cases the local non-dollar stocks have been shipped abroad. The U.S. State Department has argued that during the economic

title: Healthcare in Cuba
text: to $60. Such "under-the-table payments" reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the "Special Period" in the 1990s aggravated these payments. The advent of the "dollar economy", a legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise. Healthcare in Cuba The Cuban government operates a national health system and assumes fiscal and administrative

title: Healthcare in Cuba
text: depression "the Cuban government made a deliberate decision to continue to spend money to maintain its military and internal security apparatus at the expense of other priorities – including healthcare." However, one study found that "the available data show that the fall in Cuba's medicine imports in the '90s didn't correspond to a significant lowering of the government's healthcare spending. Budgetary support for peso-denominated spending – i.e., labor costs of medical professionals, operational costs of hospitals and clinics – has remained strong. Attempts to blame medical shortages in Cuba on resource misallocation are thus misguided, or at least wrongly nuanced."

title: Healthcare in Cuba
text: Cuba often advertises medical services it is unable to provide. Others makes similar claims, also stating that senior Communist party and military officials can access this higher quality system free of charge. In 2005, an account written by Cuban exile and critic of Fidel Castro, Carlos Wotzkow, appeared showing apparent unsanitary and unsafe conditions in the "Clínico Quirúrgico" of Havana; the article claims that health care for Cubans occurs in worse conditions in the rest of the country. An article in Canadian newspaper "National Post", based upon interviews of Cubans, finds that in reality even the most common pharmaceutical items,

title: Healthcare in Cuba
text: Healthcare in Cuba The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister for Public Health is Roberto Morales Ojeda. Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991 and the stepping up of the United States embargo against Cuba at this time also had an effect. Cuba has historically – both before and during Communist rule – performed better than other

title: Healthcare in Cuba
text: that the central revolutionary objective of free, quality medical care for all has been eroded by Cuba's need for foreign currency. Molina says that following the economic collapse known in Cuba as the Special Period, the Cuban Government established mechanisms designed to turn the medical system into a profit-making enterprise. This creates an enormous disparity in the quality of healthcare services between foreigners and Cubans leading to a form of tourist apartheid. In 1998 she said that foreign patients were routinely inadequately or falsely informed about their medical conditions to increase their medical bills or to hide the fact that

title: Health systems by country
text: charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated free in Cuban hospitals. Cuba attracts patients mostly from Latin America and Europe by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10) In 2005, Cuba spent 7.6% of GDP on health care, or US$310 per capita. Of that, approximately 91% was

title: Healthcare in Cuba
text: the Cuban economy, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the US embargo. The ending of Soviet subsidies in the early 1990s has also affected it. Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate alternative and herbal solutions to healthcare issues, which can be more accessible and affordable to a broader population In the 1990s, the Cuban Ministry of Public Health officially recognized natural and traditional medicine and began its integration into the already well established Western medicine model. Cuba had 128 physicians and

title: Healthcare in Cuba
text: using a synthetic control method found that infant mortality increased in the first years of the Castro regime relative to other similar countries, but that infant mortality reverted to trend during the 1970s irrespective of foreign aid. The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning black market economy, sometimes termed "sociolismo". According to former leading Cuban neurosurgeon and dissident Dr Hilda Molina, "The doctors in the hospitals are charging patients under the table for better or quicker service." Prices for out-of-surgery X-rays have been quoted at $50

title: Healthcare in Cuba
text: who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations and was discontinued in the 1990s. Since 1996 Cuba began the production of generic anti-retroviral drugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment. In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the Cuban National Center for Sex Education. According

title: Cuba
text: Communist government asserted that universal health care was a priority of state planning and progress was made in rural areas. Like the rest of the Cuban economy, medical care suffered from severe material shortages following the end of Soviet subsidies in 1991, and a tightening of the U.S. embargo in 1992. Challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. Cuba has the highest doctor-to-population ratio in the world and has sent thousands of doctors to more than 40 countries around the world. According to the World Health Organization, Cuba

title: Healthcare in Cuba
text: can be much higher. Cuban doctors that have been sent on international missions by the Cuban government have reported being paid less than the local doctors and treated poorly by the local government. They are sometimes monitored by the local government in case of defecting. The "San Francisco Chronicle", the "Washington Post", and National Public Radio have all reported on Cuban doctors defecting to other countries when on international missions. Cuban doctors at home have experienced an increased work-load to cover for the doctors abroad, although there is no evidence that this has negatively affected health outcomes. A 2018 paper

title: Healthcare in Cuba
text: where "social scientists frequently cited favorable health statistics supplied by [these regimes], without critically looking at the ways these were created and maintained by state power". Hirschfeld concludes that "Cuba’s health indicators are at least in some cases obtained by imposing significant costs on the Cuban population – costs that Cuban citizens are powerless to articulate or protest, and foreign researchers unable to empirically investigate." Complaints have also arisen that foreign "health tourists" paying with dollars and senior Communist party officials receive a higher quality of care than Cuban citizens. Former leading Cuban neurosurgeon and dissident Dr Hilda Molina asserts

title: Healthcare in Cuba
text: a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U.S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U.S. and elsewhere The issue of the effectiveness of the Cuban health system is politically polarized. According to William Ventres in his review of five books about Cuba's medical system (including

title: Healthcare in Cuba
text: now Cuba's single largest source for imported food. The Cuban American National Foundation (CANF) states that should Cuba choose not to purchase from the U.S., it can purchase any medicine or medical equipment it needs from other countries. Such third-country transactions only cost an estimated 2%–3% more than purchases from the U.S. as a result of higher shipping costs. CANF also asserts the United States is the largest donor of humanitarian assistance to Cuba and much of this consists of medicines and medical equipment. The US government states that since 1992, 36 out of 39 license requests from U.S. companies

title: Health in Cuba
text: 10.8. Among older adults heart disease and cancer predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization. While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as

title: Healthcare in Cuba
text: medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U.S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the Inter-American Commission on Human Rights of the Organization of American States informed the U.S. Government that such activities violate international law and has requested that the U.S. take immediate steps to exempt medicine from the embargo. The Lancet and the British Medical Journal also condemned the embargo in the 90s. The embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs

title: Healthcare in Cuba
text: professionals, "serious complaints about the intrusion of politics into medical treatment and health care decision-making". She points out that "there is no right to privacy in the physician-patient relationship in Cuba, no patients’ right of informed consent, no right to refuse treatment, and no right to protest or sue for malpractice". In her view medical care in Cuba can be dehumanizing. Hirschfeld explains also that the Cuban Ministry of Health (MINSAP) sets statistical targets that are viewed as production quotas. The most guarded is infant mortality rate. To illustrate this, Hirschfeld describes a case where a doctor said that if