Morbidity, utilization of curative care and service entry point preferences in metropolitan Centro Habana, Cuba

First-line health services with a primary health care approach are a strong
trigger for adequate health-care-seeking behavior. Research on the association
between prevalence of chronic diseases and acute illnesses and
use of health services emphasizes the importance of socioeconomic determinants
in such patterns of utilization. In a cross-sectional study of 408
families in Centro Habana, Cuba, home interviews were conducted between
April and June 2010 to analyze socio-demographic determinants
of acute and chronic health problems and use of formal health services.
Bivariate and logistic regression models were used. 529 persons reported
a chronic disease. During the previous month, 155 of the latter reported
an exacerbation and 50 experienced an unrelated acute health problem.
107 persons without chronic diseases reported acute health problems. Age
was the strongest determinant of chronic disease prevalence. Adult women
and the elderly were more likely to report acute problems. Acute patients
with underlying chronic disease used formal services more often. No
socio-demographic variable was associated with services use or consultation
with the family physician. While the family physician is defined as
the system’s entry-point, this was the case for only 54% of patients that had
used formal services, thus compromising the physician’s role in counseling
patients and summarizing their health issues. The importance of chronic
diseases highlights the need to strengthen the family physician’s pivotal
role. New economic policies in Cuba, stimulating self-employment and
private initiative, may increase the strain on the exclusively public health
care system. Still, the Cuban health system has demonstrated its ability to
adapt to new challenges, and the basic premises of Cuba’s health policy
are expected to be preserved.