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Ministry sizes up vexed issue

Private Practice: The health ministry has started studying the pros and cons of private practice, almost a year after it first allowed private participation in delivering selective diagnostic services in the country.

Although no policy states it, private practice in health care is not allowed in Bhutan.

That health care is provided free by the government and policies are silent mean private practice is not allowed, health ministry officials said.

“It’s an unwritten rule that’s being followed with policies silent on this aspect,” a health ministry official said. “It’s because of our inherent health system that there was no need to privatise health care, because the government ensures health care for all.”

The recently launched national health policy states, that private sector and foreign direct investments shall be allowed to provide high-end and specialised medical diagnostic and treatment services.

However, with demand for faster and better services growing, along with the ability of some section of the population to pay for healthcare services, the health ministry said it has to have in place a document that defines private practice, its pros and cons. “Otherwise, on what basis do we say that private practice is not allowed?” a health official said.

Besides the demand for better health care services, most doctors are also for private practice, which they feel, would inevitably come to Bhutan.  Some doctors said the health ministry working on studying the benefits and ill effects of private practice is also in response to them wanting private practice.

That more than 92 percent of the population self rated their health status as excellent, good and fair in the GNH survey indicates that health care service should be left as it is today, said health ministry officials.

“More than 90 percent stated themselves as healthy when health care is provided free, so why privatise,” a health official said. “Another important finding was that income has no impact on health, and we shouldn’t change that.”

While commending Bhutan’s primary health care services, health experts from international organisations and neigbouring countries have cautioned the health ministry to not allow private practice. “Not all doctors in Bhutan are for private practice,” a health ministry official said.

Some health officials said private practice, in an “indirect” way, is already happening, with the start of allowing private diagnostic services.  The health ministry has also issued a circular last October, stating that private diagnostic services are not allowed to prescribe medicines, and that hospitals should not “honour” prescriptions that doctors “outside the system” write.

Prescribing medicines and doing consultations, according to the ministry, is private practice.  They fear that private practice brings along cosmetic services, would not venture into disease prevention, and lose health personnel, all of which are not desirable today, said health officials.

But along with the doctors, health ministry officials also seem divided on private practice.  A health ministry official said, doctors should at least be allowed to practise privately after they superannuate, just as other professions, like teachers or engineers.

“They’ve been doing that all their lives in the hospital and, when they superannuate, they can’t practise their profession that the Constitution allows,” the health official said. “Doctors, after superannuation should either be allowed to practice privately, or should be taken back into the system on contract.”

Observers pointed out that the health ministry and the civil service commission has no reservations taking in fresh MBBS doctors, whose studies were funded by the government, but who do not get through the civil service exams, on contract.

“But they don’t want to take back senior experienced doctors on contract, even if they’re needed,” an observer said.

Doctor said times are changing and the government should explore private sector participation, so long as it’s well regulated.  A doctor said there are good and bad examples of private practice that Bhutan could look at.

“Everybody thinks private practice is bad, and the ministry is taking the easiest way out,” a doctor said. “If they’re capable of regulating it efficiently, private practice is good; but if it goes bad, it’s because of bad management, not bad practitioners, which is happening in this part of the world.”

Doctors said the increasing number of patients travelling outside the country for health care services indicates that people are willing to pay for health care.  It also means that the public health care would not be able to cater to all medical services.

“All these patients, who go abroad for treatment, go to private hospitals not public hospitals,” the doctor said.

By Sonam Pelden

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  1. I agree with you press2010. Health Service should not be privatized for larger good. I understand that doctors will say otherwise in order to open up market for them. But basic needs such as Health and Education should always be given free for benefit of all citizens. These should be treated more of right than commercial commodity. I wanted to show a youtube video on how Bhutan is seen as an example of handling health care. Unfortunately my youtube isnt working. We all know how messed up Health Care has got in US. So, I would URGE government NOT to privatize the health service.

  2. why we have to privatise health care…? when we cannot afford to buy a single tab.of paracetamol from the market. Government is providing with free of cost…and its sort of KIDU from our beloved king. Why to choose Hell when we are in Heaven…

    Individuals cannot afford to receive this privatise health care system, haves and haves not problem will arise, Poor will die.
    Commercialization of health care is not at all acceptable as it leads to money laundering through doctors and makes the wealth concentrated in the hands of the branded health care service providers. It hones the skills to tap the unlimited opportunities it gets by providing health care for higher rates thus making these institutions the “money foxes.” Privatization can lead to dominate the health care sector by showing its monopoly nature and makes the service of health care availability for poorer a mirage. It squeezes the money for their wealth hunger from the poor. Though quality is a positive side of commercialization of health care; it doesn’t mean it will always deliver the right service for the innocent people. It may further lead to black marketing of blood, organs and other medically valuable parts from the patients who cannot raise their voice if anything happens against them. Medical scams are a possibility if the health care commercialization takes place, leaving no space for poorer to avail the opportunity of getting best health care services.
    I think government must frames the rules that such practices will no longer entertain in our country in the interest of people of Bhutan….

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