As a poor country, Cuba can’t afford to equivocate and waste money on health care. Much advanced technology is unavailable. So the system is forced instead to keep people healthy. This pressure seems to have created efficiency.

It’s largely done, as the BBC has reported, through an innovative approach to primary care. Family doctors work in clinics and care for everyone in the surrounding neighborhood. At least once a year, the doctor knocks on your front door (or elsewhere, if you prefer) for a check-up. More than the standard American ritual of listening to your heart and lungs and asking if you’ve noticed any blood coming out of you abnormally, these check-ups involve extensive questions about jobs and social lives and environment—information that’s aided by being right there in a person’s home.

Then the doctors put patients into risk categories and determine how often they need to be seen in the future. Unlike the often fragmented U.S. system where people bounce around between specialists and hospitals, Cuba fosters a holistic approach centered around on a relationship with a primary-care physician. Taxpayer investment in education about smoking, eating, and exercising comes directly from these family doctors—who people trust, and who can tailor recommendations.

The system requires around twice as many primary-care doctors per capita as we have in the U.S., made possible because the country also invested in medical education, creating in 1998 what U.N. Secretary General Ban Ki-moon called “the world’s most advanced medical school.”