Cuba Reaffirms Ban on Private Medical Practice Amid Health System Crisis

This Tuesday, the Cuban government reaffirmed its ban on private medical practice by enacting Decree 160 of 2026, as published in Official Gazette No. 62. This decree, which reserves technical and professional medical, social, and dental services for the National Health System, comes at a time of severe health crisis.

The decree, endorsed by the Council of Ministers and signed by Prime Minister Manuel Marrero Cruz on July 22, is set to take effect on August 4, a week after its publication. It repeals Decree 107 from August 2, 2024, and introduces varied regulations based on the type of non-state economic actor involved.

The decree categorizes "technical and professional activities of medical and social care, or those related to healthcare services, including dental services, both inside and outside the National Health System" as activities "not authorized for non-state economic actors, reserved for the National Health System and its free nature."

Additionally, non-state economic actors are prohibited from conducting medical and scientific research on human subjects. However, the decree allows authorized and certified entities to conduct such research, provided they have an ethics committee for research and are associated with the biopharmaceutical industry.

Conversely, Decree 160 of 2026 from the Council of Ministers permits, with prior authorization or licensing, pharmaceutical, optical, care, and rehabilitation services, which are classified as "authorizable or conditional" activities.

This prohibition is not a new development; Decree 107 of 2024 already included clinical and care services among 125 activities that private micro, small, and medium enterprises, non-agricultural cooperatives, and self-employed workers could not pursue.

What differentiates Decree 160 is its more detailed and differentiated regulatory framework based on the type of economic actor. However, the core of the healthcare prohibition remains unchanged.

Public Health Law No. 165/2023, published in the Official Gazette on January 23, 2026, strengthened state control over healthcare professionals and did not open medical care to private practice. Decree 160 now reaffirms this state exclusivity.

The decree itself mandates that the Council of Ministers must review its provisions at least every two years, as proposed by the National Institute of Non-State Economic Actors. This theoretically leaves room for future changes in a system that, for now, continues to reject a private alternative for professional medical and dental services.

This decision comes amid one of the most critical periods for Cuba's health system in decades. Health Minister José Ángel Portal Miranda acknowledged an "unprecedented structural crisis" before the National Assembly in July 2025, with only about 30% of essential medications available.

The waiting list for surgeries highlights the extent of the collapse: in March 2026, there were 96,387 patients awaiting operations, including 11,193 children. By July, Deputy Prime Minister Eduardo Martínez Díaz reported that this number had surpassed 100,000, with over 10,000 minors still waiting for surgery.

Infant mortality, once a showcase indicator of the socialist model, had risen to 9.3 deaths per 1,000 live births, more than double the historical levels of four to five.

The crisis is compounded by drug shortages, deteriorating infrastructure, and a mass exodus of professionals. In May, over 300 Cuban doctors residing in the United States found themselves in a migration limbo preventing them from working. To practice their profession, they must undergo a complex and costly revalidation process that can take up to five years.