I have received news that a short article submitted to Health Policy & Planning has been accepted for publication. In the article, I argue that the statistics regarding Cuba’s health care are distorted by the incentives generated by the target system under which physicians must operate (at the threat of penalties). To meet their targets, they re-categorize early neonatal deaths as late fetal deaths so as to not swell the infant mortality rate. They also pressure women into having abortions (sometimes, they are coerced) if they feel that a risky pregnancy might endanger the achievement of the centrally-fixed targets. I show that this lead to a mild overestimation of the level of life expectancy at birth (between 0.22 and 1.79 years).
In addition, non-health related policies help explain a large share of the outcomes. Notably, restrictions on car ownership have made Cuba one of the country with the lowest ratio of deaths in accidents to population. This is important because in countries like Brazil, which has 8 times the car ownership rate of Cuba, traffic accidents are estimated to reduce male life expectancy at birth by 0.8 years.
Overall, me and my co-authors (Ben Powell and Gilbert Berdine) posit the possibility that Cuba’s much-lauded health outcomes result in large part from heavy-handed coercive measures that distort incentives and from non-health related coercive policies. In essence, we are arguing that the wheat cannot be separated from the chaff. The “bads” (the regime’s coerciveness) cannot be disentangled from the “goods”.