Government reviews DSA support for ex-country referrals as costs continue to rise

The Finance Minister Lyonpo Lekey Dorji said that the Royal Government of Bhutan fully recognizes the significant financial and emotional burden faced by patients and their attendants who are referred outside the country for critical treatments, such as kidney transplants.

According to Lyonpo Lekey Dorji, the proposal was reviewed within the broader context of the revised ex-country patient referral guidelines, and Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) / National Medical Services (NMS) has been advised to develop a clear and comprehensive cost-sharing framework, with well-defined operational modalities, before any increase in Daily Subsistence Allowance (DSA) can be considered.

This approach is informed by the rapid and sustained escalation in the cost of ex-country medical referrals, which has placed increasing pressure on public finances. Lyonpo said, “Total expenditure on patient referrals abroad has increased by over 300 percent from Nu 175 million (mn) in Financial Year (FY) 2013-4 to Nu 712 mn in FY 2024-25.”

Lyonpo also said, “Over the same period, the average cost per patient has also risen by over four times, from Nu 0.141 mn to Nu 0.573 mn.”

This represents an increase of over Nu 537 mn, amounting to more than a 300 percent rise in fiscal outlay over the period, reflecting a compounded growth that significantly outpaces general expenditure growth in many sectors.

Lyonpo said, “This trend reflects not only the increasing number of referrals, but also the rising complexity, duration, and cost of treatments, particularly for long-term and high-cost interventions, such as organ transplants.”

Moreover, in this context, any revision to the DSA, while addressing genuine needs, must be carefully considered within a broader policy framework to ensure that support measures remain equitable, fiscally sustainable, and consistent across all categories of patients requiring referral care.

“Accordingly, the MoF has recommended that any enhancement of the DSA be linked to a structured cost-sharing mechanism to ensure a fair and balanced distribution of financial responsibility,” Lyonpo Dorji said.

The ministry has also called for improvements in domestic healthcare capacity. JDWNRH/NMS has been advised to review and update referral exclusion criteria to better reflect treatments that can now be provided within the country.

According to the MoF, this is expected to gradually reduce reliance on overseas referrals, optimize the use of national healthcare infrastructure, and improve overall system efficiency.

JDWNRH/NMS is currently in the process of developing a comprehensive proposal that incorporates these considerations, including the cost-sharing framework and operational modalities.

According to the Ministry of Health, the proposal will be reviewed and finalized upon completion and subsequent government approval.