In the last decade, Bhutan’s spending on overseas medical referrals has surged over 300%, prompting the government to pursue a structured cost-sharing framework prior to any adjustments to the Daily Subsistence Allowance (DSA) provided to patients and attendants seeking treatment abroad. The Ministry of Health recognizes the financial and emotional challenges faced by patients requiring critical care outside the country, including complex procedures like kidney transplants, making support for such patients a national priority.
Overseas medical treatment is a notable component of Bhutan’s public health referral system, necessitating travel for specialized services not available domestically. These referrals often result in prolonged treatments, multiple consultations, and additional living costs, imposing significant financial strain on families despite existing government support mechanisms. The Ministry of Finance clarified that the proposal to enhance the DSA has not been rejected but requires a comprehensive cost-sharing plan with clear operational structures before any increase can be entertained.
Since FY 2013–14, overall expenditures for patient referrals abroad rose from Nu. 175 million to Nu. 712 million by FY 2024–25, with the average cost per patient escalating from Nu. 0.141 million to Nu. 0.573 million due to increased referral numbers and more complex treatment needs. The rising costs, particularly for long-term interventions, have prompted calls for a more structured policy approach to financial aid for overseas treatments.
Currently, the DSA stands at Nu. 150 per day for the first month of treatment and Nu. 125 thereafter; however, discussions are underway to raise this to Nu. 400 per day. This proposed increase aims to alleviate financial burdens while accounting for inflation and wage growth. The Ministry of Finance emphasizes that any revisions to the DSA should be assessed within a wider policy context to maintain equity, consistency, and fiscal sustainability.
Furthermore, the ministry has suggested linking any DSA enhancements to a structured cost-sharing mechanism to equitably distribute financial responsibilities between the government and those receiving assistance. Alongside financial considerations, there are concurrent efforts to enhance domestic healthcare services, including reviewing and updating referral exclusion criteria to minimize unnecessary overseas referrals and optimize local healthcare infrastructure.
JDWNRH/NMS is in the process of developing a comprehensive proposal that includes the cost-sharing framework, which will be submitted to the government for review. Nonetheless, a definitive timeline for this completion has not been established, as it hinges on the endorsement of the revised framework. As dialogue about overseas medical referrals progresses, the government aims to balance patient support with long-term fiscal responsibilities amid rising healthcare costs globally.