All healthcare in Cuba is run by the government. Cuba has practiced Western medicine to a high standard from the early 19th century and has produced some notable doctors. The country was the first to develop a vaccine against meningitis B, plus pioneering treatments for hepatitis B, diabetic foot complaints, vitiligo and psoriasis.

Cuba spent 10.57% of its GDP on health in 2015, which is a little higher than the global average. Infant mortality is on a par with Western countries and life expectancy is comparatively high, well into the late 70s (it runs close to life expectancy rates in the US). The Cuban administration prioritises disease prevention, universal coverage and access to treatment. Leading causes of death in Cuba are from non-communicable diseases such as cancer, heart disease and strokes, which is more typical of developed nations.

The Cuban national healthcare system is structured into tiers:

• the community itself: individuals and families
• family doctor-and-nurse teams, who live above government medical facilities
• basic work teams
• community polyclinics
• hospitals
• medical institutes

Family doctor-and-nurse teams work on the basis of the Continuous Assessment and Risk Evaluation (CARE) method, monitoring patient health by examining community and home environments, current health, and medical history.

These teams are supported by specialists in clinical facilities. The Cuban training systems are embedded within the public healthcare system: having qualified, most Cuban doctors go to work in primary care first, thus giving them an understanding of community healthcare from the ground up. The island has around 452 outpatient clinics and in the region of 13,000 GPs.

However, Fidel Castro’s ‘army of white coats’ has been declining in numbers in recent years. Between 2009 and 2014 the number of family doctors fell by 62%, from 34,261 to 12,842, according to Cuba’s National Statistics Office (ONEI). Cubans complain that their health system is becoming ramshackle.

There is an emphasis on foreign missions. In 2014, the Cuban authorities estimated that overseas healthcare services would bring $8.2 billion into the country. As an example, Cuba supplies medical personnel in missions to Venezuela, which ‘pays’ in oil. Thus there is a focus on sending doctors abroad, in exchange for lucrative contracts – but this has an impact on public healthcare at home. Doctors are eager to work abroad, as salaries are so low in Cuba. In 2013-14, 3,000 doctors essentially defected to the USA, often via Venezuela.

The Ministry of Foreign Trade reports that medical products and services, (including doctors), pharmaceuticals, and medical tourism currently account for 70% of Cuba’s export revenues. Cuba is thus the other way round from many other small nations, who seek to attract medical tourists into their countries: Cuba, by contrast, exports medics out.

Cuba has universal coverage so everyone is entitled to state healthcare. As an expat, however, you will have access to special clinics. These are government run, not private, but are of a higher standard than most other local provisions.

All travellers into Cuba are obliged to have travel insurance with medical cover before they enter the country (in addition to a return air ticket, proof of sufficient funds, and a valid visa). You may be required to show proof of this when you come into Cuba and you can also purchase insurance from Cuban companies at points of entry. Your insurance should have – at minimum – cover for medical evacuation, emergencies and repatriation of remains.

You will not need to apply to be covered by the national system, although you will need to have cover before you enter the country. Covreage will be automatic, but as an expat, you will also be entitled to access private clinics.

The Cuban system is developed into tiers, with a focus on primary and community care, but also encompassing hospital and specialist treatment. This includes:

• rural medical service networks
• polyclinics
• hospitals
• preventive and specialist treatment centers

Practices are responsible for a pool of around 1000 – 1500 patients. GPs must visit every patient at home at least once every year. Cuba also has 12 specialist units and a number of biomedical companies which are engaged in cutting edge research.

You will be covered but as an expat, you will have access to special clinics.

If you are studying in Cuba, you will need travel insurance with medical cover before you enter.

Your family will need to have travel insurance with medical cover.

Dental treatment is covered by state health insurance and is free, but if you can afford it, you will be expected to pay for some dental procedures.

The government assumes all fiscal responsibility for the healthcare of its citizens, so you will not experience payroll deductions.

You will need travel insurance with medical cover before coming into the country, but you may opt for comprehensive international health insurance as well. You will need to show proof of this, and you will not be permitted to leave Cuba if you have outstanding medical bills. You will have to pay in cash for any treatment, as Cuba does not accept overseas credit cards.

Cuba differs from other Caribbean nations in that there is no private healthcare on the island. However, the government runs specialized clinics which are open to tourists, VIPs and expats. Most tourist resorts in Cuba have international clinics, such as Havana, Varadero, and Santa Lucia. Expats in Havana usually access Cira Garcia Hospital: it is known as a “tourist” hospital.

With a local provider (listed below), you could be looking at a monthly premium of $125 – 175 depending on age and gender.

You should be able to obtain either travel insurance with medical cover or comprehensive health insurance from the main providers, including:

• Allianz Assistance
• AXA
• Cigna
• Pacific Prime

Owing to trade sanctions, some insurers cannot make payments to bank accounts belonging to Cuban banks or to Cuban providers. Check with your insurance company before applying. Members in Cuba must have a bank account outside the country.

Cuba is Spanish-speaking but many medical personnel, due to having worked abroad, also speak English and may speak some French, as well. Expats report relatively few linguistic difficulties at the tourist hospitals.