Overseas medical referrals surges more than threefold, rising from Nu 175 million in the 2013–14 fiscal year to Nu 712 million in 2024–25
The Royal Government has reaffirmed its commitment to supporting Bhutanese patients referred abroad for life-saving medical treatment, even as it confronts a steep and unsustainable rise in overseas medical expenditure. During Friday’s (April 3, 2026) virtual Meet the Press, the Minister (Lyonpo) of Finance, Lekey Dorji, sought to dispel public concern by clarifying that the government has not rejected the proposal to increase the Daily Subsistence Allowance (DSA) for patients and their attendants. Instead, the ministry is undertaking a rigorous and comprehensive review to ensure that any enhancement to the allowance is financially prudent and systematically consistent.
Lyonpo explained that the DSA proposal cannot be reviewed in isolation. It must be part of a broader reform of ex-country patient referral guidelines, which currently face unprecedented strain. The Ministry of Finance has requested the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) and the National Medical Services (NMS) to first prepare a robust cost-sharing framework. This framework is expected to clarify who pays for what, how exceptions are considered, and what operational rules must be followed so that support remains equitable, transparent and sustainable.
The Minister explained that over the past decade, public spending on overseas medical referrals has surged more than threefold, rising from Nu 175 million in the 2013–14 fiscal year to Nu 712 million in 2024–25. This represents an increase of more than Nu 537 million. The cost per patient has also more than quadrupled over the same period, increasing from Nu 0.141 million to Nu 0.573 million. These spiraling costs reflect not only a rise in the number of referrals but also the growing complexity and duration of treatments, particularly high-cost procedures such as organ transplants, advanced cancer therapies and long-term interventions that require extended stays abroad.
The Finance Minister noted that such financial pressures demand thoughtful policymaking rather than ad-hoc decisions. Raising the DSA may appear straightforward, but without a clear framework governing referrals and support mechanisms, the system risks becoming inconsistent and fiscally vulnerable. The government, he said, must ensure that assistance reaches those who need it most while maintaining the long-term sustainability of Bhutan’s health financing.
At the same time, Bhutan’s healthcare landscape has changed significantly in recent years. The country has steadily built its domestic capacity for treatments that once required referral abroad. This includes expanding cardiac services, strengthening dialysis facilities, upgrading diagnostic capabilities and improving cancer care. With these developments, the MOF has directed JDWNRH and NMS to review and update the exclusion criteria for referrals. The intention is to ensure that only cases that genuinely require specialized care overseas are sent abroad, while treatments that can now be handled domestically are retained within the country to reduce costs and improve efficiency.
The referral overhaul currently being drafted by JDWNRH and NMS is expected to be wide-ranging. It will include revised criteria for when and how patients are referred outside Bhutan, proposed adjustments to DSA, detailed guidelines for financial responsibility and clearly defined operational procedures. Once finalized, the proposal will be forwarded to the government for evaluation and approval. While the minister did not commit to a timeline, he assured that work is progressing with urgency and seriousness, given the stakes involved.
Beyond the policy specifics, the issue touches deeply on public sentiment. Bhutanese families undergoing treatment abroad already face significant emotional and financial burdens. While the government covers major medical expenses, attendants often struggle with mounting costs for food, lodging, transport and extended stays. Many households have advocated for higher DSA to ease these pressures. The minister acknowledged these concerns and reiterated that the government recognizes the hardships faced by patients and their families. However, he cautioned that any increase must reflect a careful balance between compassion and fiscal responsibility.
Nidup Lhamo from Thimphu
