Bhutan’s household health expenditure is on Rimdros and transportation

Bhutan is third in essential health service coverage and fourth in financial protection among 11 South East Asian countries according to the UHC (Universal Health Coverage) essential service coverage index of the World Health Organisation.

However in Bhutan, a large proportion of household spending on health related to transportation costs. This could be attributed to the country’s terrain, which affects access to health services according to the System Review of the Kingdom of Bhutan.

The review states that transportation costs could also have been incurred in accessing specialized care. For instance, a patient from the eastern or central part of the country prescribed a CT scan has to travel to the national referral hospital as such services are available only there.

The payment for rimdro, a ritual practice based in Buddhist culture, was also seen as a unique case for Bhutan. According to the Bhutan Living Standards Survey 2012, more than half, 56.5 per cent of the total health expenditure related to health, was paid for rimdro.

“To promote physical and mental health and well being, and to extend life expectancy for all, we must achieve Universal Health Coverage (UHC), including financial risk protection, access to quality essential health care services, medicines and vaccines for all,” said Dr Phyllida Travis, Director of the Department of Health System Development, WHO.

“All people aspire to receive quality, affordable health care. UHC is about people having access to the health care they need without suffering financial hardship. UHC aims to achieve better health and development outcomes, help prevent people from falling into poverty due to illness, and give people the opportunity to lead healthier, more productive lives,” she added.

Ensuring a country’s progress towards UHC such that a basket of health services is available to everyone without causing financial hardship has become high on the policy agenda. Based on the Global Health Expenditure Database, Out Of Pocket (OOP) as percentage of the total health expenditure declined from 1995 till 2010 but increased by a percent in 2014. OOP at 12 per cent of the total health expenditure in 2014 is lower than that of other countries of the South East Asia Region.