A lack of regulation had caused the health ministry to suspend the issuance of licenses for private diagnostic centres in the country for the past two years.

There are two proposals pending with the ministry to establish a new diagnostic centre in Gelephu and Samdrupjongkhar.

A draft regulation will be presented to the Bhutan Medical and Health Council’s (BMHC) governing council, the topmost body of the council chaired by the health minister on May 3.

Registrar Sonam Dorji said that the Council’s executive committee approved the draft and the regulation will come into effect once the governing council endorses it, probably by June this year.

Health officials said that licenses for the existing 12 private diagnostic centres were issued as per the guidelines, which prescribed procedures for submitting the proposal to establish private diagnostic services in the country.

There are six private diagnostic centres in Phuentsholing while Thimphu, Gelephu and Samdrupjongkhar have two each.

Sonam Dorji said there was a need for a regulation because the guideline doesn’t clearly specify the implications a centre could face should it fail to comply with the rules.

The new regulation, among others, will include professional requirements for establishing a private clinic, the services a particular clinic is required to provide, standard operating procedures and legal reference.

He said the regulation not only concentrates on diagnostic services but also on other kinds of private health services. “This is mainly to avoid double work of drafting regulation for each and every new private clinic proposal like dental and dermatology the ministry will receive.”

He pointed out that there are many private candidates pursuing a career in medicine, who may be interested in opening a private clinic. Sonam Dorji said the country could expect more private dental clinics because the requirement of dentists in the civil service has almost saturated.

“Some centres are going beyond the scope of diagnostic services and prescribing medicines, which is not allowed,” he said. “The council is unable to regulate such problems because of lack of regulation in place.”

With the regulation in place, every service of a private diagnostic centre will be scrutinised, Sonam Dorji said.  “We will provide technical authorization for each services only if the committee is satisfied with the proposal,” he said. “The services will also be regulated properly.”

Health secretary Dr Ugen Dophu said that once the regulation comes into effect, the ministry will approve the proposals. However, he said that the ministry would have to limit the number of private diagnostic centres.

By economic theory there should not be a limit but there are many problems if you provide license to every application, Dr Ugen Dophu said.

“We don’t want to have many private diagnostic centres that it becomes difficult to monitor later,” the health secretary said. “There are rules and regulations regarding alcohol sale in the country but it cannot be enforced because there are so many bars in the country that it is not possible to monitor each and every bar,” he said. “This is a challenge and we don’t want that to happen in the health sector.”

The ministry is however yet to decide on the limit on private diagnostic centres.

Dr Ballab Sharma with the Padkar Diagnostic Centre said that the ministry’s plan to limit the issuance of license to operate private diagnostic centres in the country contradicts the new economic development policy, which states that the government is prioritising private practice in Bhutan.

Dr Ballab Sharma said that besides endoscopy, ultrasound and laboratory services, his centre submitted proposal for Echo diagnosis, which the ministry withheld. The centre plans to propose for X-ray services.

“I have been in this service for so many years and we get patients who come for diagnosis but they also want my opinion on their disease,” Dr Ballab Sharma said adding that some patients who get diagnosed at the hospital visit the centre to consult them. “As a medical specialist, I give them my opinion on their disease but I don’t charge a penny for the consultation,” he said. “Patients pay for the services they obtain from the centre, not for the consultation. I am giving my free service by prescribing to my patients.”

He said that he prescribes medicine because he has a valid license from the BMHC, which states that he can practice anywhere in the country. “It doesn’t say anywhere that once I leave the civil service, I am not allowed to practice,” he said. “Some private diagnostic centres in the country are run by private individuals and some even by contractors.”

In such cases, the centres refer the patient to hospitals. “I find it a waste of time when a patient after diagnosis goes back to the hospital to queue to see a health assistant,” Dr Ballab Sharma said.

Dechen Tshomo