HAVANA When Jose Luis Cabrera had coronary by-pass surgery after a heart attack five years ago, his wife had to bring food and clean sheets to him in the hospital. The operation itself didn't cost the Cuban couple a cent.
"I am so grateful. They saved his life," said his wife, Daisy Martinez, who works as a cleaner in an office. "It would have cost a fortune in the United States."
Hospitals in Cuba are often shabby and badly-lit, and lack equipment and medicines. But the health system built by President Fidel Castro's government has produced results on a par with rich nations using the resources of a developing country.
Experts say that is because Cuba focused on prevention and because its universal free health care allows Cubans to see a doctor quickly and treat illness before it needs costly procedures.
The Cuban system is extolled in filmmaker Michael Moore's new documentary "SiCKO," which argues that U.S. health care tends more to the profits of insurance and pharmaceutical companies than to public health.
To make his point, Moore goes to Communist Cuba with a group of Americans who suffer from health problems derived from working as volunteers in the ruins of New York's World Trade Center after the attacks of September 11, 2001.
The film, which is due to open in U.S. theaters on June 29, makes the point that the treatment they lack in the United States is available for free in Cuba.
On key statistics measured by the World Health Organization, Cuba is in line with the United States.
The average life expectancy of a child born in Cuba is 77.2 years, compared with 77.9 years in the United States, according to the WHO.
The number of children dying before their fifth birthday is seven per 1,000 live births in Cuba and eight per 1,000 in the United States.
Yet the United States spends more than 26 times as much on health, $6,096 per person a year, compared with only $229 in Cuba, the WHO figures show.
DOCTORS FOR EXPORT
While Cuba has 73,000 doctors, twice as many doctors per capita as the United States, in recent years it has sent as many as 15,000 to work in the slums of Venezuela, its main political ally, in exchange for vital oil supplies.
The export of medical services has hurt Cuba's family doctor system and caused longer waits at health centers.
At the Havana clinic where Moore's American patients received free check-ups in March for respiratory problems and bone fractures suffered at Ground Zero, Ivonne Torres reads a Buddhist text as she waits for an appointment.
"The attention is pretty good, but it was a million times better six years ago, when we always saw the same doctor," said Torres, who suffers from tachycardia.
"The advantage is that it's free," Torres said. Medicine is often in short supply, even over-the-counter drugs, she said.
While Moore got free care in Cuba, most foreigners pay, in what some critics call a "two-tiered system" where elite hospitals are reserved for the Communist leadership and celebrities such as Argentine soccer idol Diego Maradona.
"In Cuba, the elite hospitals are as good as here, if not better," said Leonel Cordova, a Cuban doctor who works as a emergency room physician at Miami's Baptist Hospital.
"The hospitals dedicated to the health of regular citizens are a disaster," said Cordova, who was sent to work in Zimbabwe and defected in 2000. At these hospitals, Cubans bring personal items such as towels, bed sheets, soap and even food, he said.
And while Cuba holds up its health care system as one of the achievements of the revolution launched by Cuban leader Fidel Castro in 1959, critics of the Cuban government say health care and other social benefits have come at a cost of political freedom in a one-party state.
Still, Cuba is a model for other developing countries that cannot afford costly medical treatment and where preventing illness makes good economic sense, said Gail Reed, producer of a recent documentary on Cuban health care called "Salud!"
Dr. David Hickey, a transplant surgeon at Beaumont Hospital in Dublin, said Cuba is a world leader in primary health care based on preventive medicine.
"It's a very sobering experience for someone coming from the affluent West to see what they can achieve," he said.
Hickey, an honorary professor of surgery at Havana University, said he had nothing to teach Cuban doctors who do heart, kidney, pancreas and liver transplants.
A decades-old U.S. trade embargo against Cuba forced it to develop its own molecular biology industry, which produces innovative drugs that prevent rejection in transplants.
Cuba has developed the world's first Meningitis B vaccine which is available in Third World countries but not in Europe or the United States due to U.S. sanctions.
Hickey said Cuba's health care budget was no larger that his hospital's.
"Cuba looks after 11 million with the same budget and produces better health care in terms of life expectancy, infant mortality and vaccination rates than we do," he said.
(additional reporting by Lisa Baertlein in Los Angeles)