The writer argues against the introduction of private medical practice in the country
The issue of private practice has been in the web of national thinking for quite some time now. The debate has been mostly in the public domain but, as a Bhutanese, who will be affected by any decision on the issue, it is our right and responsibility to think about it too.
I have personally come to the conclusion that health care should remain exclusively an affair of the state. The feasibility and viability aspects of any proposition determine its outcome. I believe the small size of our country and population satisfies both these considerations. Besides, it keeps alive the legacy of the Bhutanese monarch caring for his people. Then, more importantly, in a small society such as ours, it would weaken the thread of cohesion, to have two separate systems: one for the haves and the other for the have-nots; a mediocre government-run service for the poor and a fancy well equipped private service for the rich. Such an arrangement would sow seeds for jealousy, resentment and eventually discontentment – elements that will not help in the realisation of a GNH society.
There are other concerns about privatisation of health care. You can put a price tag on a pair of shoes or a branded compound bow. The buyer could make a smart move, or be fooled; but fortunately there is always a next time and he will get it right, then. At a hospital, however, where the seller is the expert and the authority, how are you going to make that sound purchase decision? When treatment means putting potent chemicals into your body, or the conducting an invasive surgery, it is unlikely you will get a second chance to play smart.
The thought for privatisation is believed to stem from the growing demand for better health care services on the one hand, and the inability of the government to provide it, on the other, because of resource constraints. But I believe, if one considers carefully and comprehensively, the resources are there. Take into account the millions we spend each year in government referrals to Vellore, Kolkata and other places in India, and Bangkok in Thailand. The actual figure, it is believed, is higher; add to that, the cost of privately funded treatment, which must be sizable, considering that our Bhutanese now travel all the way to Bangkok even for deliveries. And, note, our people are always drawn to the more expensive hospitals, and spend generously.
It does not matter whether the funds are coming from state coffers or private pockets; it is all Bhutanese money. If we can appreciate this point of view, realise how much we are spending anyway, it is not difficult to see that the prospect of establishing a good health care system at home is actually within our reach. To use a parallel, it would be wiser to take a loan and buy the apartment outright, instead of paying huge rentals each month. After that you can live in the comfort of security and a peace of mind.
When it comes to investing in health care, it is not a gamble and there is no risk. Good health is the most precious gift in our lives, for without it, in spite of all the riches and power we may have, life is meaningless.
You will understand, just how desirable it is to have a good health care system with qualified doctors, right here at home, when a close and a loved one is seriously ill and the hospital is short of what is needed.
If we can convince banks to lend us money to build towns on prime agricultural land, surely they will support us to improve our hospitals. Similarly, if we feel rich enough to spend millions of dollars on consultancy fees, surely we can afford to hire doctors from outside to meet our temporary shortfalls.
Even as we may plan to realise such a dream, I understand there is much that we can immediately do to help ourselves. Aside from the issue of resource constraints, a fundamental complaint is about administrative control. Voices from the hospital commonly echo of the maladministration by the health ministry and the civil service commission. It is incomprehensible why it must be so, and continue to remain that way. Now that the ballot box is here, cannot the will of the majority fix such a shameful problem?
The shortage of manpower is an issue that predictably features in any discussion of our health system. While this is a legitimate challenge, we are profoundly guilty of being negligent and wasteful with this scarce resource. We routinely make administrators of doctors, and retire them like civil servants, even though they may be at peak performance levels. Why can’t we help ourselves, by letting doctors work for longer years? When they get too senior in age, but are still willing to practise, they could work for fewer hours a day and a shorter week. Even when they cannot see patients, they can still be available for consultation by junior doctors. Senior doctors represent a rich and vast reservoir of knowledge and experience; we would be so foolish to throw it away, especially when we are so desperate in this respect.
Yes, we need to step up our handling of this special resource. When the survival of a loved one rests with the doctors, you begin to see how godly these people are. An experience like this humbles you to believe that any other work is only secondary to the medical one.
Our doctors in Bhutan, for the most part, represent the top academic performers of the education system. Privileged by merit, this bright lot is sent to medical schools abroad at great cost to the country. Upon return, they are expected to serve with visible illustration, their greater intellect and training, and gratitude to the government and people for the special training opportunities accorded to them. It is in this light, that we find it regrettable that some doctors chose to opt out of the profession. Imagine all that valuable training that will be shelved and eventually lost, and the opportunity cost to the people, and not just in financial terms, but also in terms of time loss. Medical schools are not only expensive, but it takes one longer to graduate from one. One cannot help but lose some regard for a person, who has the know-how and the skills to save lives, but simply abandons it all for another calling in his or her life.
But then, doctors are human, and it is the responsibility of the system to ensure that our doctors remain committed to their profession. The work they do is special; it is at the tender most spot of every individual in society. Therefore, our best efforts must be directed at facilitating their work; and we must also ensure they make a good living, so that they are not eyeing greener pastures elsewhere. In addition to all that we may do, to keep them happy, it is fundamental that there exists a binding legal framework to secure the desired fidelity.
I should like to believe that my views will be shared in many quarters. Let us keep our health system totally public and state-run; and let us do what is needed to get our standards to the regional level, and keep all our treatment and medical spending here at home.