As discussions on privatizing aspects of Bhutan’s healthcare system continue, the Ministry of Health (MoH) has cautioned that an unchecked expansion of private healthcare could undermine the country’s long-standing commitment to universal health coverage.
In a detailed assessment presented to the National Council (NC), the MoH identified major risks related to equity, affordability, workforce retention, governance, and patient safety, while acknowledging that carefully regulated private participation could help ease pressure on public hospitals.
The assessment warns that without strong safeguards, privatization could weaken free and equitable healthcare access, particularly for low-income and rural populations.
“Poorly regulated private healthcare expansion could undermine Bhutan’s universal health coverage system,” the report states.
To examine whether private providers could complement public healthcare delivery, authorities conducted a broad mixed-methods assessment involving quantitative analysis, international case studies, stakeholder consultations, and field observations.
The review examined healthcare models from Asia, Africa, and high-income countries and included national surveys, focus group discussions, and visits to existing private facilities such as diagnostic centres, optical shops, and wellness service providers.
A national pulse survey involving 717 respondents found growing public willingness to access regulated private healthcare services, particularly for diagnostics, outpatient care, dental services, dermatology, and optometry.
Many respondents believed private participation could improve service quality, shorten waiting times, and increase responsiveness. However, the MoH stressed that such gains would only materialize under robust regulation.
One of the report’s strongest concerns relates to equity and financial protection.
According to the assessment, increased private sector participation could lead to greater out-of-pocket spending, potentially weakening Bhutan’s tradition of free healthcare.
Low-income and vulnerable groups may struggle to afford private services, widening disparities between wealthier and poorer households.
The report also warned of a growing urban-rural divide, noting that private healthcare providers are likely to concentrate in profitable urban centres, leaving rural communities underserved.
“There is a potential for widening disparities in access to healthcare services between urban and rural populations,” the assessment stated.
The ministry further cautioned that unregulated commercialization could result in quality healthcare becoming increasingly concentrated in cities, while rural populations continue to face shortages.
Another major concern is the possible migration of skilled health workers from the public system into private practice.
The assessment warns of a potential “brain drain effect,” where experienced doctors, nurses, and specialists may leave government hospitals for higher-paying private opportunities.
Such movement, officials said, could weaken already stretched public services, particularly in remote areas facing shortages of trained personnel.
The issue of dual practice — where public healthcare professionals simultaneously work in private facilities — also emerged as a concern.
While dual employment could help retain professionals within Bhutan, authorities warned it may reduce productivity in public hospitals and create conflicts of interest if left poorly regulated.
“Over time, these dynamics may contribute to inequitable distribution of human resources, particularly affecting rural and public service delivery capacity,” the report noted.
Patient safety and quality assurance were also identified as significant risk areas.
Site visits and consultations revealed inconsistencies in clinical standards, infrastructure quality, and provider qualifications among existing private facilities. The absence of standardized patient record systems in some centres was flagged as a challenge that could compromise continuity of care and accountability.
The report also highlighted weaknesses in Bhutan’s regulatory and governance systems.
According to the assessment, the country currently lacks comprehensive authorization and inspection systems capable of effectively monitoring private healthcare providers.
Weak enforcement capacity, limited inspection mechanisms, and inadequate integration of private facilities into national health information systems were identified as major gaps.
“These gaps present risks to quality assurance and system accountability,” the report stated.
The MoH also warned against unregulated market growth, cautioning that weak oversight could lead to price escalation, monopolistic behaviour, and distorted healthcare priorities.
Despite the concerns, the assessment acknowledged that carefully governed private participation could complement the public system.
Experts consulted during the review agreed that selective private involvement could help reduce congestion in public hospitals, improve access to diagnostics and elective services, and introduce innovation into healthcare delivery.
The report recommends a phased approach beginning with “low-risk, high-demand services,” including diagnostics, outpatient consultations, and selected elective procedures.
Healthcare providers, regulators, civil society representatives, and technical experts also stressed the need for strict pricing oversight, licensing frameworks, mandatory recordkeeping, and safeguards to ensure equitable access.
The assessment concludes that while private healthcare offers “clear complementary potential,” its success will depend on strong regulation, workforce protection, and governance systems aligned with Bhutan’s universal healthcare vision.
Tashi Namgyal, Thimphu
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