why doesn't Cuban medical tourism industry service Americans offshore?

more specifically, why don’t they open clinics in the neighboring Dominican Republic or Haiti and hence allow American tourists (who are not allowed to go to Cuba) to take advantage of their services? After all, if a combination of artificially low salaries and decently competent doctors is making their medical tourism establishment so competitive and good value for the money, why not expand to new markets?

Probably because the primary function of the Cuban health system is to service the needs of the people of Cuba and the profit motive doesn’t really function in a communist state. I doubt whether the Cuban regime would allow their health professionals to exit the country if this was what they were leaving to do anyway.

You have the Cuban health system all wrong. There are at least three tiers of medical care in Cuba, at the top it is the system reserved for government dignitaries. This is the system that famously failed Fidel Castro, but then recovered by flying in high priced help from Spain.

At a lower level you have medical tourism, this the system that services foreigners, not always tourists, in exchange for hard cash. This is the system that was shown to Michael Moore when he made his documentary.

At the very bottom you have the system available to ordinary Cubans. This is the system that has been exposed time and time again but people outside of Cuba continue to ignore its reality. In this system doctors are shipped overseas to work in Venezuela. In this system medicines are not available at all, for example if you need an operation you have better get anesthesia in the black market, because the hospital won’t have any.

To answer your question about why Cuban doesn’t open clinics in DR and other countries. Why would those countries allow that? They have their own medical systems that foreigners can access, under what circumstances would they benefit by bringing in Cuba as a partner?

edited to delete

Why would the Cuban government want to provide medical care to people in another country?

In the case of Venezuela, it was for propaganda purposes - showing solidarity with another socialist and anti-American leader. It is essentially the same reason Chavez gave cheap heating oil to poor people in the United States while ordinary Venezuelans weren’t doing so hot.