The Bhutanese Leading the way.
But not privatization of the current free medical services
The Ministry of Economic Affairs was tasked by the government as one of the key agencies to come up with various recommendations to help the economy to deal with the COVID-19 impact.
The MoEA as part of its recommendations has recommended that the government should permit private investment in healthcare without limitations of medical care, diagnosis and prescription of drugs.
Currently, only private diagnostic centers are allowed and that too to strictly give diagnostic services like Endoscopy, blood tests, X-ray with no patient diagnosis, treatment or prescription and sale of medicines allowed.
It has also called for the immediate lifting of suspensions of approvals for various private medical services and instead asked for a focus on ex-post monitoring.
The above recommendation essentially means allowing private health care in the country from private hospitals to clinics and doctors providing a range of medical services.
Something which the Ministry of Health and various governments until now have stubbornly resisted.
The logic for the MoEA is both an economic one and also that of services. An official said that already large numbers of Bhutanese travel abroad for private medical procedures or medical care and this results in a lot of money and particularly foreign exchange leaving the country.
The logic is that a private health care industry in Bhutan would also create jobs for local Bhutanese.
Private clinics would also provide an option for those who can pay and take away the load on the current public-only health system.
An important clarification from the ministry is that this does not mean that the current public health system will be privatized as institutions like the JDWNRH hospital will continue to provide free medical services and medicines.
A traditional argument against allowing private healthcare in the country is ensuring equity of service and also to prevent doctors in the public servitor from joining private hospitals.
Here an official pointed out that already many Bhutanese go abroad for private medical services.
As for doctors the official said that a doctor who has paid for his or her own MBBS should be allowed to open a private practice.
For those doctors on government scholarship an arrangement can always be made like in other countries where for a certain number of hours like from 9 am to 3 pma doctor provides free public service and can then do private practice after that.
In the current situation the MoH has even limited the number of diagnostic centers making it a monopoly situation. Private health services are also subject to several dos and don’ts by bureaucrats from the MoH.
EDP 2016 allowed private investment
In 2016 when the former government revamped the umbrella Economic Policy Document one major change was allowing private investment in the Health sector.
The EDP 2016 said that selective services in the health sector will be opened to private investment and practices and the government will regulate the quality of health services and human resources.
The EDP 2016 document which still stands and is on the MoEA website says that given the critical shortage of health personnel in the country, private sector involved in health care will be allowed to bring in the required expatriate medical and health professionals in keeping with rules and regulations as prescribed by Medical and Health Council Act, 2002.
It says the Ministry of Health will adopt a policy to open selective health services to private investments including traditional medicines by 2017.
It says the government will promote the country to become a center for health and wellness tourism focusing on niche areas.
The policy says the health sector as a major service activity has immense potential to earn foreign exchange and generate employment. It says the niche area is to provide high-end luxury medical facilities in the country.
However, the EDP policy also clarifies that the government will continue to provide free health care through the public hospital network both in modern and traditional medical systems.
It says the participation of the private sector or foreign companies and individuals in the health sector shall not under any circumstance, lead to privatization of the public health services.
The EDP 2016 had made these changes as an emerging middle class was willing to pay for its own medical services with many going abroad to access even basic services and in the process spending foreign exchange on travel and stay abroad. The argument was also lessening the pressure on the public health system apart from encouraging medical tourism to Bhutan.
The EDP 2016 policy was launched in early 2017 but subsequently despite the pronouncements in the EDP 2016 the MoH did not move on this and it is still left hanging.
One of the many other areas which can be opened up to privatization and thereby ready access for people to better health care services, without needing to travel outside country in times of illness and suffering.