28 January, 2010 – The health ministry could start charging non-Bhutanese for health services and Bhutanese who come to referral hospitals even when not referred as a means to generate more revenue to sustain the health system.
These were two recommendations made by experts, to generate revenue without having to do a study, at a meeting in Paro yesterday where health officials explored options for more revenue and improving efficiency of the health system.
Selectively introducing private participation, initially in the non-clinical sector and then in the clinical sector, was another alternative suggested. But health officials said this needed caution. “Many countries are trying to get out of the grip of private health care practice because patients have become customers and hospitals, five star hotels,” said the health secretary, Dasho (Dr) Gado Tshering.
A health official cited the example of China, which opened the market to privatisation overnight. “Studies show that poverty levels increased by 20 percent,” he said.
Increasing the health tax was another thoroughly discussed option. But finance ministry officials said the one percent health tax paid by government and corporate employees goes to the government not the health ministry.
According to the finance ministry Nu 58.2 mn was collected as health contribution in 2008. The government’s spending on health shot up from Nu 768 mn in 2000 to Nu 1,792 mn in 2008.
An economist from the World Bank, Dr George Schieber, said that revenue enhancement has nothing to do with efficiency.
With Bhutan about to cross the threshold of a least developed country (LDC), health officials said that it would be difficult to get donor funds. Which is why the health ministry need to look at options to financially sustain its healthcare services.
Other options recommended were the use of information technology (IT), separation of the payer and the provider, starting a co-payment mechanism where those with the ability to pay could pay for health services and starting a paid evening clinic in public hospitals.
Starting a paid evening clinic in public hospitals received a lukewarm response. UNICEF representative, Dr Gepke Hingst, said that it would increase disparity. “Equity and GNH may not be there with paid evening clinics,” she said.
The feasibility of foreign direct investment (FDI) in tertiary healthcare services and wellness tourism was another option discussed. But WHO consultant, Dr Soonman Kwon, said that while wellness tourism may be okay starting a tertiary healthcare would be difficult. “You should have a target and think whether you have the capacity to be competitive because FDI in health sector would mean opening the market,” he said. “Please don’t over estimate yourself to do well in this very saturated market.”
The health secretary said that defining the group who shouldn’t be paying has been a major problem. Dr Kwon cautioned that in low-income countries, there are lots of “politically poor” people.
But the concept of splitting the payer (the finance ministry) and the provider (the health ministry) was however not well understood by the participants as the three-day workshop closed yesterday in Paro. One of the McKinsey experts, Dr Mandar Vaidya, explained that by separation they meant that a body should be formed to monitor and manage healthcare services in the ministry. “Irrespective of the health ministry’s revenue collection methodology, there needs to be an entity in the ministry, which holds itself responsible for healthcare services management,” said Dr Vaidya.
Lack of proper planning was also pointed out as one of the reasons for inefficiency. “There is poor utilisation of funds,” said a health official. “Some of us are not able to fully utilise the funds while some have no funds at all.”
By Sonam Pelden
