The Bhutan Innovation Lab found that long waiting times and overcrowding at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) stem from system-level gaps rather than just hospital inefficiencies. Patients bypass primary care and referral protocols due to low health literacy, weak gatekeeping, and unreliable appointment systems (walk-in tokens, phone bookings, partial ePIS rollout). This overloads JDWNRH while underusing other facilities and drives up costs.

The Lab identified three leverage points: (1) strengthen pre-arrival awareness and health literacy, (2) enforce referral pathways and pre-booked appointments, and (3) redesign hospital scheduling and token systems. It proposed 44 interconnected interventions, including expanding Thromde Health Centre use, shifting to referral-only specialist access, and optimising token caps. The Prime Minister has directed immediate actions to decentralise care, improve emergency flow, strengthen digital tools (ePIS), and ensure more predictable, fair, and efficient access to hospital services.