Health ministry to revamp patient referral system

Dechen Tshomo

The health ministry is reviewing the patient referral system and working towards instituting an innovative system to ease the challenges faced by patients and attendants.

Health Minister Dechen Wangmo said patients and attendants from villages having to go to Calcutta in India for treatment face cultural shock besides other problems such as language barrier.

Lyonpo said that when her mother had to undergo cancer treatment in India, her family members too faced various challenges.

“I want to review and revamp the system within a year,” lyonpo said. “So that our people can get treatment in the comfort of our own loved ones, in the comfort of our own country without having the challenges of language barrier, cultural barrier, and environment.”

Since the government is paying for the referrals, Lyonpo said it intended to do it comprehensively. “Providing quality care is our vision.”

Instead of sending patients outside, the ministry will consider bringing in doctors or specialist into the country to treat the patients.

This, lyonpo said, would not only encourage the exchange of knowledge but the greater benefit would be to the people and the nation. 

 “When we refer our patients abroad, our doctors are not getting exposed to anything. If we bring the expert here, our people will have an opportunity to learn. There will be a transfer of knowledge and skill to our own doctors.”

Lyonpo said there was a need to reduce referrals by a certain percent and be able to introduce these services here in the country.

Referring to the increasing number of cancer patients in the country, Lyonpo said people were dying of cancer and the disease was consuming the nation. “Every third person you talk to has somebody who is affected by cancer in Bhutan today.”

Lyonpo said it was time to come up with an innovative way to address these issues to benefit the people, the nation and the health system. For a nation with about 700,000 people, it does not need a huge number of medical specialists, she added.

According to the statistics with JDWNRH, the number of referrals is decreasing but the cost is increasing.

The hospital referred about 900 patients abroad in 2018, 191 less than the previous year.

In the last five years, the hospital recorded the highest referral cases in 2016-17 fiscal (1,478), 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 2019-20, the hospital referred more than 280 patients to Vellore and Calcutta in India.

“Epidemiologically, if you look at it, cancer is one example,” lyonpo said. “By the time they come to health facilities it is too late or at a much later stage so there are many complications associated with it.” When the patient is referred to at much later stage, the per capita cost of treating one referral case goes up.

Lyonpo said that for a health system that is fully funded by the state, investing in prevention was important. “Our primary objective should be the prevention of diseases.” The ministry, lyonpo said, must invest in prevention and early diagnosis or screening so that people were diagnosed early.

The second priority would be in the early stage so that the treatment outcomes are better. “That is the strategy,” Lyonpo said. “If you look at the data, this is where the ministry of health is gearing towards.  We want to look at evidence and design intervention, not for political or any other reason.”

The health flagship began from December last year with the screening of the women for cervical cancer in the three dzongkhags in the first phase. The programme will go nationwide.

Lyonpo said if the focus was on treating only it would drain the resources because treatment became expensive.

“So, we need to look at it holistically and then think about instituting good systems in place. We should design the system in a way so that we can take care of the weakest and the most vulnerable,” Lyonpo said.

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