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In one TV spot, a woman visits a doctor and requests a long list of pills. Asked why she needs so many, she replies: “Oh, doctor, it’s for my personal stash.”

“I stop cold when I see that, not knowing whether to laugh or cry,” blogger Greter Torres Vazquez wrote on a Cuban youth-issues website. “Maybe they’ve never had the experience of going to the pharmacy and asking for medicine that their aunt, their grandmother, their mother needs urgently, only for the worker to say `Sorry, we ran out five minutes ago.’”

Some seized on the campaign to complain about corruption in hospitals.

“They should also publish the miserable salary that doctors get paid; that’s an embarrassment,” said Maria Soto, a 62-year-old Havana resident. “And it’s serious, because it leads to the problems everyone knows about: You get bad service or, even worse, they charge you under the table.”

Cuban authorities continuously brag about keeping health care free and universal despite its lightweight economy and the 50-year-old U.S. embargo.

Experts credit the government’s emphasis on prevention and doctor-patient relationships for life expectancy and infant mortality rates that are on par with those of wealthy nations. Medical schools churn out huge graduating classes; every last one of Cuba’s 11 million citizens is supposed to get a house call at least once a year.

Charging for care would be a dramatic and unlikely about-face, but with 15 percent of the budget devoted to health, Havana sees no choice but to make the system more efficient wherever it can.

After steadily rising over five decades to hit $206 million in 2009, health spending has dropped, slipping to $190 million last year, according to government figures. Officials hint at more cuts to come.

These days, authorities rail against “irrational expenses” and have slashed more than 50,000 less-skilled health-sector jobs, singling out overstaffed clinics and ambulances with multiple drivers.

Some Cubans say hospital wait times seem to be on the rise and medicine, equipment and soap are increasingly in short supply.

The clinical doctor consulted by the AP said neither scarcity nor complaints have worsened, though doctors still suffer heavy case loads and low pay, about $25 a month.

Cuba is walking a delicate line on health: Too much change could be seen in some camps as a betrayal of the socialist contract. Too little may not ease the burden on a strained economy, said Sergio Diaz-Briquets, a U.S.-based demographer and author of “The Health Revolution in Cuba.

“It is maybe a universal phenomenon that health care systems are expensive,” he said, “but Cuba perhaps cannot afford to have the kind of services that they claim to have had in the past.”


Associated Press writers Andrea Rodriguez and Anne-Marie Garcia contributed to this report.

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