About that Cuban Life Expectancy
By David Henderson
Cuban health statistics appear to be a paradox. Wealth and health are correlated because greater wealth can buy better health care. Yet, Cuba remains desperately poor and appears to be healthy. Cuban life expectancies of 79.5 years and infant mortality rates of 4.3 per 1000 live births (2015) compare well with rich nations like the USA (78.7 years and 5.7 per 1, 000 live births) yet its per capita income of 7602.3$ make it one of the poorest economies in the hemisphere (World Development Indicators DataBank, 2017).
How is Cuba healthy while poor? Most attribute the fact to Cuba’s zero monetary cost health care system. There is some truth to that attribution. With 11.1% of GDP dedicated to health care and 0.8% of the population working as physicians, a substantial amount of resources is directed towards reducing infant mortality and increasing longevity. An economy with centralized economic planning by government like that of Cuba can force more resources into an industry than its population might desire in order to achieve improved outcomes in that industry at the expense of other goods and services the population might more highly desire.
This is from Gilbert Berdine, Vincent Geloso, and Benjamin Powell, “Cuban infant mortality and longevity: health care or repression?“, Health Policy and Planning, Vol. 33, Issue 6, 1 July 2018: 755-757.
When they write “zero monetary cost,” the authors clearly mean “zero monetary price.”
But then the authors look carefully behind the statistics and what they find is not pretty.
Centralized planning has disadvantages. Physicians are given health outcome targets to meet or face penalties. This provides incentives to manipulate data. Take Cuba’s much praised infant mortality rate for example. In most countries, the ratio of the numbers of neonatal deaths and late fetal deaths stay within a certain range of each other as they have many common causes and determinants. One study found that that while the ratio of late fetal deaths to early neonatal deaths in countries with available data stood between 1.04 and 3.03 (Gonzalez, 2015)—a ratio which is representative of Latin American countries as well (Gonzalez and Gilleskie, 2017).2 Cuba, with a ratio of 6, was a clear outlier. This skewed ratio is evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.3 Cuban doctors were re-categorizing neonatal deaths as late fetal deaths in order for doctors to meet government targets for infant mortality.
Using the ratios found for other countries, corrections were proposed to the statistics published by the Cuban government: instead of 5.79 per 1000 births, the rate stands between 7.45 and 11.16 per 1000 births. Recalculating life expectancy at birth to account for these corrections (using WHO life tables and assuming that they are accurate depictions of reality), the life expectancy at birth of men [falls] by between 0.22 and 0.55 years (Gonzalez, 2015).
Coercing or pressuring patients into having abortions artificially improve[s] infant mortality by preventing marginally riskier births from occurring help[s] doctors meet their centrally fixed targets. At 72.8 abortions per 100 births, Cuba has one of the highest abortion rates in the world.6 If only 5% of the abortions are actually pressured abortions meant to keep health statistics up, life expectancy at birth must be lowered by a sizeable amount. If we combine the misreporting of late fetal deaths and pressured abortions, life expectancy would drop by between 1.46 and 1.79 years for men. In Figure 1 below, we show that that with this adjustment alone, instead of being first in the ranking of life expectancy at birth for men in Latin America and the Caribbean, Cuba falls either to the third or fourth place depending on the range.7
H/T2 Vincent Geloso.