The Health Minister Lyonpo Dechen Wangmo said the Ministry of Health is in the process of reviewing its Health Policy which will be presented to the cabinet. The current policy was put out in 2011.
She said that the policy among other things will allow for private investment in health care, but with a clear framework set by the policy.
The minister at the outset clarified that private investment in health care or privatization does not mean privatizing any of the current free and public health services, which will continue to remain free and is also the main focus of the government.
“I think we must have a clear framework to privatize health care with protocols. Small mom and pop stores kind of clinics with a single doctor will not do. There has to be quality of care. The SOPs and standards will be set by the ministry,” said Lyonpo.
Lyonpo said that her view is that these private investments should be for health facilities with global standards and so the framework would ensure quality investments.
The minister said that eventually Bhutan would have such facilities once the framework is known.
Lyonpo said that one aspect is that biggest challenge in the country is providing tertiary care to the people.
Lyonpo said that the FDI policy of 2019 already allows private investment in health care. She said in fact even the 2011 Health Policy allows for private investment.
The 2011 Health Policy under Public-Private Partnerships section says ‘Strategic mechanisms for participation of the private sector in the risk free and feasible areas in health shall be explored with necessary regulations in place. Private sector and FDI shall be allowed to provide high-end and specialized medical diagnostic and treatment services in compliance with the National standards and Laws.’
It also says, “Ministry of Health shall continue to outsource nonclinical and selective diagnostic services.”
The 2019 FDI policy allows 100 percent FDI in health with a minimum investment of Nu 200 mn. It opens up ‘All-inclusive specialized hospital services’ which applies to hospitals providing at least one procedure presently referred outside country and having its own complete set of diagnostic services and laboratory facilities.
It also opens up Specialized Medical Services, Specialized Dental Services, Specialized Medical Laboratory Services, Specialized Diagnostic imaging services and Specialized Traditional Medical Services.
The Economic Development Policy 2016 not only allows private investment but also allows foreign doctors and health workers to be brought in and it also says the country will be a center of health and wellness tourism.
The Ministry of Economic Affairs in its recent economic revitalization strategy after COVID recommends that the government should permit private investments in healthcare without limitations of medical care, diagnosis and prescription of drugs.
However, despite the several policies and recommendations above the ball has always stopped at the MoH which is yet to outline the details, standards, conditions and protocols around private investment in health.
This looks set to change with the new health policy which will seek to address these issues too.
Lyonpo said that though the 2011 Health Policy talks of private investment, but it is very vague and not clear.
She said that an important part of the decision making process is to look at the data on how many would avail such high end diagnostic or other private services, how they envision Bhutan’s health system, if the current system is good for us, evaluating the impact of past policies and trends of economic growth.
The minister said that while coming up with the policies and the framework everything under the sun needs to be looked at on whether privatization should happen in a phased manner, should it be based on certain services and what is the demand.
“We should get our facts and figures right,” said Lyonpo.
Lyonpo, however, said that often people confuse private investment and privatization with privatization of public health services.
She said that the Constitution itself does not allow the privatization of free public health care and so no public medical services would be privatized.
The minister was asked on why the MoH in the past had not followed the various policies from EDP to FDI that allowed private investment.
Lyonpo said that there was no framework earlier which is now being created and the strategy also needs to be very clear.
Another argument that some people have put up against the entry of private hospitals and care in Bhutan is that it would take away or attract the doctors in the public sector.
Lyonpo said that one would have to look at the demographic position in Thimphu and see how many can afford private healthcare.
“We have to look at the facts and figures. 60 to 70 percent of our population are in the rural community, and so brain drain from the government to private sector is a very biased assumption as the doctors will have to be paid and if there are not many patients then how can they be paid.”
She said if there is no demand then the issue of having supply or not, does not arise.
Lyonpo said that private investment must be looked at in terms of the demand, size and goals.
She said that the government’s focus is on enhancing the quality of the public health sector. She said Bhutan must have international standards and it will have a public multidisciplinary hospital in the JDWNRH which can deal with transplanting kidney, organ transplant, cancer, cardiology, infertility etc.
She said that some of the old infrastructure going back to the 1960’s will have to be demolished to make away from this new multidisciplinary hospital.
When asked about a growing middle class heading out for medical procedures the minister said that while the government would provide all medical services it cannot provide cosmetic surgery procedures like braces, teeth whitening, double eyelids etc.
The minister said that the upcoming health policy would harmonize private investment in health care.
The demand for private health care has been growing in the country as increasingly large numbers of Bhutanese head out to Siliguri, Kathmandu, Delhi, Kolkata, Bangkok and other places for even simple medical procedures like dental work.
This means not only foreign exchange leaving the country for these procedures but also the associated costs of travel and stay.
On the other hand, there is growing pressure on Bhutan’s public health system with increasing number of patients and the largely same facilities and medical staff numbers unable to keep up. One idea is that those who can afford and do not have the time can opt for private medical care.
Public healthcare also imposes a heavy and growing annual resource burden on the state exchequer.
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