This report is the outcome of a costing study undertaken to obtain information about the costs of delivering health services at different administrative health care levels in Bhutan, to:Inform the Ministry of Health about the costs of delivering various types of services at different levels; • Increase cost-awareness and knowledge about healthcare delivery costs among policy researchers and the general public; Support future evidence-based and informed policy decisions to increase efficiency of the Bhutanese health sector. The study reviewed healthcare costs and activities in 9 districts, covering a total of 12 facilities, including: the National Referral Hospital, the 2 Regional Referral Hospitals, 4 district hospitals, two 10- bedded hospitals and 3 primary health centers. The study made use of an easily replicable methodology to assess the cost of resources used to provide services covering the 2018/2019 financial year. The study also updates a similar study undertaken in 2011 for the 2009/2010 financial year. For the purposes of the study, a costing model was developed using internationally recognized methodologies that were adjusted to the Bhutanese health system.