Tenzin Karma, Dorji Thinley, Dorji Gampo, Lucero-Prisno Don Eliseo
Faculty of Postgraduate Medicine Khesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan.
Department of Internal Medicine Central Regional Referral Hospital Gelegphu Bhutan.
Public Health Chall. 2022 Nov 2;1(4):e34. doi: 10.1002/puh2.34. eCollection 2022 Dec.
Bhutan has a free healthcare system that covers almost 90% of the population within 2 h of travel distance. The country has achieved remarkable success in many public health indicators despite the chronic shortage of financial resources and trained manpower. However, there are many aspects of health inequities in the government's health policies, programmes and health services. The Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu in 2020 hosted a policy dialogue on health equity in the context of the Bhutanese health system. With changing demographics and socioeconomic conditions, some of the factors that earlier determined an equitable distribution of services and resources are no longer relevant now. The referral system is easily bypassed not only because the patients have easy access to transportation to tertiary hospitals, but because of frequent interruptions in the service and the non-availability of doctors in the district and general hospitals. The role of the private sector is restricted to a few diagnostic services while there is an apparent adequate spending capacity of consumers. There is an important component of out-of-pocket expenditure and catastrophic health expenditure in patients seeking treatments outside the country. The current health policies and strategic plans for the future lack a measure of health equity. We recommend conscientious assessment of health inequities in the current system and introducing policies and programmes to prevent the worsening of such inequities.
不丹拥有一个免费医疗体系，该体系覆盖了近90%居住在2小时行程范围内的人口。尽管财政资源和专业人才长期短缺，但该国在许多公共卫生指标方面取得了显著成功。然而，政府的卫生政策、项目和卫生服务存在诸多卫生公平方面的问题。2020年，位于廷布的不丹凯萨尔·嘉波医科大学举办了一场关于不丹卫生系统背景下卫生公平的政策对话。随着人口结构和社会经济状况的变化，一些早期决定服务和资源公平分配的因素现在已不再适用。转诊系统很容易被绕过，这不仅是因为患者能够轻松前往三级医院，还因为服务频繁中断以及地区医院和综合医院缺乏医生。私营部门的作用仅限于少数诊断服务，而消费者显然有足够的消费能力。在寻求国外治疗的患者中，自付费用和灾难性医疗支出占了很大一部分。当前的卫生政策和未来战略计划缺乏对卫生公平的考量。我们建议认真评估当前体系中的卫生不公平现象，并出台政策和项目以防止此类不公平现象恶化。
