Tshering Ugyen, Sharma Jayendra, Tshering Dorji, Dendup Tandin
Department of Public Health Ministry of Health Thimphu Bhutan.
Center for Health Policy Thimphu Bhutan.
Public Health Chall. 2024 Jul 8;3(3):e216. doi: 10.1002/puh2.216. eCollection 2024 Sep.
Deeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision-making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision-making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.
不丹的医疗体系深深植根于其国民幸福总值（GNH）的发展理念，致力于实现全民健康覆盖（UHC）这一共同目标。尽管主要由政府提供资金，但该卫生系统仍面临诸多挑战。为克服这些障碍并实现全民健康覆盖目标，扩大卫生领域的财政空间和提高运营效率至关重要。本文旨在探讨不丹不断演变的医疗格局，并通过两种政策选择推动全民健康覆盖的实现。第一种政策选择侧重于通过利用健康税来改善健康结果和促进财政可持续性这一双重目标，而第二种选择则强调在不丹卫生系统中加强系统性的卫生技术评估（HTA）。首先，借鉴全球经验，政策简报建议利用健康税来降低社会和医疗成本，并增强卫生部门的财政可持续性。考虑到不丹烟草和酒精消费的高流行率，并利用正在进行的商品及服务税（GST）改革的契机，持续倡导健康税至关重要，并且可以考虑对健康税进行软专项拨款，以为更广泛的公共卫生项目提供资金，特别是侧重于促进健康生活方式、健康筛查和外展公共卫生活动。其次，将卫生技术评估纳入政策制定和决策过程对于全民健康覆盖中的有效资源分配至关重要。培育和加强卫生部（MoH）现有的卫生技术评估治理结构，并设立一个专门的多学科卫生技术评估委员会，将确保明智的决策和资源优化。卫生技术评估证据应为卫生服务标准的修订、临床指南的制定、采购决策和医疗保健优先事项提供参考。这些政策选择可以帮助该国提高财政可持续性，加强有效资源分配和利用，并改善医疗服务提供，符合其国民幸福总值的愿景，并最终加速实现全民健康覆盖的进程。
