Every day, the national referral hospital refers at least two patients abroad for treatment.

The hospital referred about 900 patients abroad last year, 191 less than the previous year.

In the last five years, the hospital recorded the highest referral cases in 2016 -17 fiscal year at 1,478 referrals costing the government Nu 198.23 million (M).

While referral cases decreased in the following year to 1,105 cases, the cost increased by about Nu 26M compared to the cost in 2016 -17 year.

In terms of cases, hospital officials said that cancer patients topped the referral chart, followed by cardiovascular diseases and organ transplant.

Of the 1,105-referral cases in 2017-18, the highest were cancer patients at 317 cases. Patients with ailment related to circulatory (cardiovascular system) and genitourinary (urogenital system) followed at 195 and 147 cases.

About 125 patients were referred for eye and ear problem while 91 were pregnancy related cases. About 149 referral cases were referred for other reasons like hip and knee replacement.

The hospital’s medical superintendent, Dr Gosar Pemba said that the government allocated the referral budget to the national referral hospital.

“Before a patient is referred from health centres in places like Samdrupjongkhar and Jomotsangkha, the health staff there have to discuss with a specialist at the JDWNRH,” he said. “We assess if it is convenient in terms of distance and cost to refer the patient to the nearest border town like Guwahati in Assam, India, then to bring the patient to the referral hospital in the country. We approve and pay for the referral.”

Every year, the government refers about 70 to 80 patients to hospitals in Guwahati, about five to 10 to Siliguri, and few from Gelephu to the nearest border town, Bongaigaon in Assam.

For instance, he said that if a mother is unable to give birth and has to undergo C-section within an hour, he said it is convenient to take the patient to hospitals in the border area instead of travelling to Gelephu because there is no gynaecologist in Dewathang.

“It is convenient and safer to refer the patients to the health centres across the border then to bring the patient to the district and referral hospitals which are about four to five hours drive,” he said.

A majority of referrals cases are sent to Kolkata and CMC in Vellore. Every year, JDWNRH is given a referral budget of about Nu 200M.

Dr Gosar Pemba said that sometimes the referral budget exhausts by June. “Even if the budget for the financial year is exhausted, the hospital refers patients who urgently require treatment, before the budget for the next financial year is released.”

“We also appropriate some budget for the referral from left-over budget of other activities when necessary,” he said.

In the last five years, referral cases have slightly decreased last year.

Health officials said that the decrease in the number of referrals could be because of the introduction of new services like radiotherapy at the JDWNRH.

The super-speciality hospital, which is in the plan could also reduce referral cases. The health ministry has already started developing the proposal.

According to the recent state of the nation report, the multidisciplinary super-speciality hospital is expected to generate cost savings of more than Nu 222 million annually by reducing third country referrals for cancers, cardiovascular diseases, organ transplants and neurosurgical cases.

“At an individual level, patients and family members will also benefit by reducing the expenditure that would otherwise be incurred on availing referrals abroad,” it states.

Dechen Tshomo