The health ministry on September 18 issued an executive order to reconstitute the committee to study and assess the possibility of corporatising Jigme Dorji Wangchuck National Referral Hospital (JDWNRH).
Senior officials from the ministry, JDWNRH, Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMS), and Bhutan Medical and Health Council (BMHC) met on August 18 to discuss the issue following a letter from health minister to form a high-level committee to deliberate on the proposal to make the hospital a corporation.
It was discussed during the meeting that there is a need for in-depth analysis on its implications to policy, legal, management and financial aspects. The officials expressed that constituting a committee within the ministry, JDWNRH, and KGUMS would have a conflict of interest with each organisation protecting their interests. An independent third-party review was so recommended.
The ministry wrote to the prime minister for consideration and guidance to issue the order nominating members from the finance ministry, Gross National Happiness Commission, Royal Civil Service Commission, BMHC, Drug Regulatory Authority, Druk Holding and Investments and any member as deemed necessary to form an independent third-party multi-sectorial review committee.
Health secretary, Dr Ugen Dophu, said that one of the terms of reference of the order is for the committee to study the functioning of JDWNRH as an autonomous agency and determine areas for improvement.
The committee is also required to study and provide in-depth analysis considering policy, legal, management and financial implications of corporatising JDWNRH as well as maintaining the status quo.
The first sitting of the committee will be conducted on September 28. Thereafter, the committee will meet every fortnight or as and when required.
The executive order states that GNHC shall function as the lead of the committee and ensure that the assignment is completed on time.
The committee is expected to complete the task by December and the findings and recommendations of the study should be presented to the government.
Following the health ministry’s statement on exploring corporatising of JDWNRH as a way to retain medical specialist and improve healthcare services in the country, concerns were raised on the corporatisation leading to privatisation of healthcare services.
The Constitutional mandate was referred to in the concerns raising questions on what constitutes basic healthcare.
The Constitution mandates the state to provide free access to basic public health services both in modern and traditional medicines.
“Thanks to our visionary kings, they have given us free basic healthcare which the ministry defines as all care from head to toe,” Dr Ugen Dophu said.
He said that in Bhutan, all care from head to toe is basic healthcare, except for cosmetic services like secondary and tertiary dental care like braces and crowning, and luxuries like cabin and helicopter service. “If a patient can be referred by an ambulance but he demands helicopter then he will not get the service by helicopter. If the medical doctor requires a patient to be airlifted then only he will get the helicopter service,” he said.
Organ transplant except for kidney, cornea and bone marrow is not included in basic healthcare, Dr Ugen Dophu said. “These three transplants are technically and feasibly found to be effective. As medical knowledge improves, more can be added to the list.”
“This is a beautiful definition for basic health care and in times to come, Bhutan should not change this definition because the definition is acceptable to reach the poor or to anyone,” Dr Ugen Dophu said. “None of us should try to define in more detail than this, otherwise all of us will suffer. If we say that the basic health care doesn’t include cancer, then many people will suffer.”
Dr Ugen Dophu said that many countries had defined basic healthcare. For instance, Thailand has 211 diseases included in the basic healthcare. “If you suffer beyond 211 diseases, then you will not get the basic healthcare.”
Dr Ugen Dophu said that the ministry had officially communicated to the economics affairs ministry a definition of basic healthcare during the former government’s time.
Medical Superintendent at JDWNRH, Dr Gosar Pemba, said whatever services the hospital provides currently is free of cost. “We don’t have the services divided like which services are to be paid or which are provided free of cost.”
Dr Gosar Pemba said the main debate on corporatisation of JDWNRH is who will pay for the health services, which the government has clearly mentioned. “The hospital will bill the government and the government will pay, not the patient.”