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