Transitional Health, Transitional Care – Part 3


Figure 1.  The changes in healthcare in the United States, China and Cuba over Time  

Note: in the US polysectarian (multiple belief  systems) existed for much of the 19th century, followed by solidification or the fields, with allopathy leading, followed by a production of mixed medical practices (MDs and DOs and DCs), maturing into “integrative medicine” (insurance coverage is included) between the 1960s and the 1980s.  Chinese medicine developed a preliminary mixed traditional chinese medicine (TCM) and western allopathy practice due to Hong Kong’s history of British influence and political-economic control.  This caused the first peak in mixed oriental-western European medicine to be fully developed around 1880. In 1950, Mao Tse Tung revived this hybridization of the two practices by demonstrating the use of acupuncture on cardiac surgical patients treated using an up-to-date, western medicine cardiac surgery unit.  This resulted in the continuation of both of these practices and the emergence of other combined TCM and non-TCM Chinese health practices.  Cuba’s program remained typical for one of a developing country.  Mostly western medicine was practiced, with local indigenous and family/cultural practices engaged in on the side.  When communism arrived, there was little change in the western practice, but  socialist teachings had an impact on the quality and types of care to be offered.  Cuba’s greatest changes, along with those of the U.S., were the technological achievements it incorporated.  Cuba has served as an example for developed countries like the U.S. because it  produced  into a very patient-friendly, sociologically integrated, community/family-care  program, referred to as the polyclinic program. (For much more on this history, see

 Part 3 

Results of Study

The following are the results of a review of the number of core physicians found in each of the three countries evaluated (Fried & Gaydos, 2012).



Table 1.  Physician:Patient Ratios (Fried & Gaydos, 2012)



Figure 2.  Size-adjusted pie chart depictions of the three healthcare systems, relative to numbers of patients per evaluated primary care provider


Three Types

These are the types of health care providers that service the majority of patients.  A count of the numbers of these physicians, related to the numbers of patients they are responsible for in theory for the entire country, produced the above results.  The relative size of the pie chart depicts the relationship between number of patients per primary care provider (PCP), including some specialists.  The Patient:Practitioner ratio defined the figure size; the pie itself depicts the distributions by degree and specialty.  (Note: no age-gender adjustments were made for this model)

Important to note are the following:

  1. Even though its population is very large, China, has a mid-range ratio for its  Patients per PCP (22,894 patients per practitioner).
  2. The US has the greatest theoretical number of patients per PCP for these data.
  3. Cuba in turn, with its polyclinic set-up, has the greatest number of practitioners per patient available for care.


To compare the differences in how each of these three systems perform, the following depicts those diseases shared by these countries, which have mortality rates that can be evaluated, expressed at numbers of deaths per 100,000 patients, per year:



Table 2.  Death Rates for Six Chronic and One Preventable Disease Groups (

The next section provides figures summarizing the findings from this review.  The ways in which expenses are defined vary greatly between these three programs.  As noted in an earlier figure, reposted here for convenience (Table 3), Cuban government extensively subsidizes its costs for care and in the study of its utilization by Hadad and Allen (2012).  Four key points can be made from this study.


Table 3.  United States, China and Cuban Healthcare Costs, relative to GNP, GDP, with Sources for Payment Plans and Healthcare Coverage.


Point 1.  Due to its size and complexity, the U.S. system demonstrates more details, in terms of forms of expenditures and how these costs are covered (Figures 3 and 4).  The U.S. system has effectively defined its ranking in the international programs, and has plans established on paper for how to best integrate with a theoretical global healthcare program (Figure 5).


Figure 3. United States – Distribution of Expenses (Janjan & Gooman, 2011).


Figure 4.  United States – Distribution of Payers or Programs (Fried & Gaydos, 2012)


Figure 5.  The United States Healthcare Network (Hammond, Jafe, & Kush, 2009)


Point 2.  China also has a fairly sophisticated governing system (simplified greatly in Figure 6).  Chinese medicine also has a greater reliance upon traditional non-allopathic practices (Figure 7).


Figure 6.  Flowchart of Medical and Health Responsibilities and the Ministry of Health in China (Lai,  Hwang, & Beasley, 2011).


Figure 7.  Modern and Traditional Chinese Medicine, Combined to form a Single Program

Point 3.  Cuban healthcare has effectively integrated the former communist government or socialist tradition into its healthcare system.  The reason for its success is often puzzling to outsiders, but a key word used to define why and how it works is the socialist concept and symbolic term or catch phrase “Solidarity.”


Figure 8.  Cuban Polyclinic Medicine Network (right figure redrawn from Hadad & Allen, 2012, 311)

Point 4.  Bringing this back to the initial observation, the interest in managed care and healthcare program changes by Malaysians.  This issue is covered quite extensively in a slide presentation (see also Figure 9), which is fortunately now available on the web (Hamid, 2010).




Figure 9.  The Malaysian Health Care System (Hamid, 2010)


References (this page only)

Fried, B. J., Gaydos, L. M.  (2012). World Health Systems.  Challenges and Perspectives. 2ed. Chicago: Health Administration press.

Gaydos, C. L.  (2012).  United States of America.  In Fried, B., & Gaydos, L.M. (Eds.) World Health Systems.  Challenges and Perspectives. 2ed. (pp. 693-716).  Chicago: Health Administration Press.

Hadad, J., and Allen, E. M.  (2012).  Cuba.  In Fried, B., & Gaydos, L.M. (Eds.) World Health Systems. Challenges and Perspectives. 2ed. (pp. 301-316). Chicago: Health Administration Press.

Hamid, M bt A.  (2010).  Care for Malaysia: Restructuring the Malaysian Health System.  Presented at the 10th Malaysia Health Plan Conference by Dato’ Dr Maimunah bt A Hamid, Deputy Director General of Health (Research and Technical Support) 2nd February 2010.  Slide presentation for conference accessed at

Hammond, W. E., Jafe, C., Kush, R. D. (2009). Healthcare Standards Development. The Value of Nurturing Collaboration. Journal of AHIMA 80 (7), 44-50.  Accessed at

Janjan, N., Goodman, J.  (2011).  Conflicts of Interest in Health-care Reform?  The ASCO Post, 2 (11), Accessed at

Lai, D., Hwang, L, Beasley, R. P.  (2011).  HIV/AIDS testing at ports of entry in China. Journal of Public Health Policy 32, 251–262. doi:10.1057/jphp.2011.9

Wen, H., Hung, P., Ji, X., and Li, S.  (2012). China.  In Fried, B., & Gaydos, L.M. (Eds.) World Health Systems.  Challenges and Perspectives. 2ed. (pp. 251-268).  Chicago: Health Administration Press.




The following are recommended Readings on Chinese, Cuban and Malaysian Health Care Systems:


Chang, J., Guan, Z., Chi, I., Yang, K. H., & Bai, Z. G. (2014). Evidence-based practice in the health and social services in China: developments, strategies, and challenges. International journal of evidence-based healthcare12(1), 17-24. doi: 10.1097/01.XEB.0000444660.59606.d2

Chu, P., & Pai, P. (2015). A new great wall: commissioning a new hospital in China. Future Hospital Journal2(1), 28-33. doi: 10.7861/futurehosp.15.010

Dong, L., Christensen, T., & Painter, M. (2014). Health Care Reform in China: An Analysis of Development Trends and Lack of Implementation. International Public Management Journal, 17(4), 493-514. DOI:10.1080/10967494.2014.958802

En‐Chang, L., Meng, L., Jia, Z., & Ping, L. (2014). 2014 International Bioethics Forum Between UK and China and the Professional Development of Bioethics in China. Bioethics, 28(3), ii-iv.. DOI: 10.1111/bioe.12087

Li, H., Zhang, T., Chi, H., Chen, Y., Li, Y., & Wang, J. (2014). Mobile health in China: Current status and future development. Asian Journal of Psychiatry, 10, 101-104. doi:10.1016/j.ajp.2014.06.003

Song, P., Ren, Z., Theodoratou, E., Guo, S., & An, L. (2014). An analysis of women’s and children’s health professional requirements in China in 2010 based on workload. BMC health services research, 14(1), 589.. doi:10.1186/s12913-014-0589-y

Toy, M., Salomon, J. A., Jiang, H., Gui, H., Wang, H., Wang, J., … & Xie, Q. (2014). Population health impact and cost‐effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China.Hepatology60(1), 46-55. DOI: 10.1002/hep.26934. Hou, J., Michaud, C., Li, Z., Dong, Z., Sun, B., Zhang, J., … & Chen, L. (2014). Transformation of the education of health professionals in China: progress and challenges. The Lancet, 384(9945), 819-827.  doi:10.1016/S0140-6736(14)61307-6

Wong, D. F. K., Zhuang, X. Y., Pan, J. Y., & He, X. S. (2014). A critical review of mental health and mental health‐related policies in China: More actions required. International Journal of Social Welfare23(2), 195-204.. DOI: 10.1111/ijsw.12052



Allen, J. A., Bailey, D., Dubus, N., & Wichinsky, L. (2014). The Interrelationship of the Origins and Present State of Social Work in the United States and Cuba: The Power of a Profession to Bridge Cultures. Journal of Human Behavior in the Social Environment, (ahead-of-print), 1-8. DOI:10.1080/10911359.2014.953432

Burke, N. (2014). Review of Revolutionary Medicine: Health and the Body in Post‐Soviet Cuba. P. Sean Brotherton, Durham: Duke University Press, 2012, 288 pp. Medical Anthropology Quarterly, 28(2), b1-b3. DOI: 10.1111/maq.12096

Castro, M., Melluish, S., & Lorenzo, A. (2014). Cuban internationalism-An alternative form of globalization. International Review of Psychiatry, 26(5), 595-601. doi:10.3109/09540261.2014.920770

Cooper, R. S., Kennelly, J. F., & Ordunez-Garcia, P. (2006). Health in Cuba. International journal of epidemiology, 35(4), 817-824

Dubus, N., & Greene, R. (2015). Can the Council on Social Work Education Educational Policy and Accreditation Standards Be Exported to Cuba?. Journal of Human Behavior in the Social Environment, 25(1).

Herman, C., Zlotnik, J. L., Collins, S.  (nd.)  The National Association of Social Workers Leads Delegations to Cuba.  Washington DC: Social Services in Cuba.  Accessed at

Huish, R. (2014). Why Does Cuba ‘Care’So Much? Understanding the Epistemology of Solidarity in Global Health Outreach. Public Health Ethics, 7(3), 261-276. doi: 10.1093/phe/phu033

McCulloch, A. (2015). Revolutionary Doctors: How Venezuela and Cuba Are Changing the World’s Conception of Health Care. Capital & Class, 39(1), 172.

Rodríguez, A. R. V. (2014). Implications of biotechnology for Public Health in Cuba. Humanidades Médicas 14 (1), 206-219. Accessed at

The story behind Cuba’s deal to send doctors to Brazil.

VEGA, R. A. (2015). Conceiving Cuba: Reproduction, Women, and the State in the Post‐Soviet Era. Elise Andaya. New Brunswick, NJ: Rutgers University Press, 2014. 169 pp. American Ethnologist, 42(1), 190-191.



Hassali, M. A., Li, V., & See, O. G. (2014). Pharmacy practice in Malaysia. Journal of Pharmacy Practice and Research, 44(3), 125-128. DOI: 10.1002/jppr.1024

Inche Zainal Abidin, S., Sutan, R., & Shamsuddin, K. (2014). Prevalence and Determinants of Appropriate Health Seeking Behaviour among Known Diabetics: Results from a Community-Based Survey. Advances in Epidemiology. doi:10.1155/2014/793286

Lee, Y. K., Low, W. Y., Lee, P. Y., & Ng, C. J. (2014). Factors influencing decision‐making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation. International Journal of Nursing Practice. DOI: 10.1111/ijn.12355.

Leeves, G., & Soyiri, I. (2015). Does More Education Always Lead to Better Health? Evidence from Rural Malaysia. BioMed Research International. doi:10.1155/2015/539212

Michael, J. M. (2015). The Origins of the Asia-Pacific Academic Consortium for Public Health and the Philosophy Behind Its Establishment. Asia-Pacific Journal of Public Health, 27(1), 7-10. doi:10.1177/1010539514562526

Sooryanarayana, R., Choo, W. Y., Hairi, N. N., Chinna, K., & Bulgiba, A. (2015). Insight Into Elder Abuse Among Urban Poor of Kuala Lumpur, Malaysia—A Middle‐Income Developing Country. Journal of the American Geriatrics Society, 63(1), 180-182. DOI: 10.1111/jgs.13217




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