title: Shifting the demand for emergency care in Cuba's health system.
abstract: Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995-2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients' expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. pdevos@itg.be
authors.forename: Pol
authors.initials: P
authors.lastname: De Vos
authors.forename: Pedro
authors.initials: P
authors.lastname: Murlá
authors.forename: Armando
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Mariano
authors.initials: M
authors.lastname: Bonet
authors.forename: Pedro
authors.initials: P
authors.lastname: Màs
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D003462:Cuba; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration