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BANGKOK, January 16, 2026 – Worried about potential gaps in healthcare coverage, a growing number of Thais are purchasing supplemental health insurance despite having access to the country’s global healthcare schemes, a trend fueled by concerns over insufficient funding.This reflects a broader anxiety about the long-term sustainability of Thailand’s public health system.
Rising Fears Over Healthcare funding
Many Thai citizens are increasingly anxious about the financial stability of their national health insurance and social security benefits.
- A lack of adequate funding for the “gold card” national health insurance and social security is driving public concern.
- The current budget allocation system, especially for inpatient services, is insufficient to cover actual hospital costs.
- Policymakers need to address the budget shortfall and restore the negotiating power of the National Health Security Office (NHSO).
- Increasing tax collection and implementing necessary reforms, like the recent social security wage ceiling adjustment, are crucial for long-term sustainability.
Dr. wirot Setthakorn, a specialist in Health and Agricultural Policy at the Thailand Growth Research Institute (TDRI), highlighted these anxieties during a forum on health system reform organized by the National Health Commission Office (NHCO) and partners at the Parliament Building. He noted that individuals with “gold card” national health insurance and social security rights are expressing a lack of confidence in their coverage, fearing that treatment may not be fully covered due to budgetary constraints.
the “gold card” system, in particular, is a source of worry. Past budget allocations have been deemed insufficient to meet actual hospital service demands,leading to financial losses for hospitals and requiring regular subsidies from the central government. This instability fuels public apprehension.
“For example, the reimbursement rate for inpatient services (IP), the hospital expects to receive reimbursement at the rate of 8,350 baht/AdjRW for every patient, but with the patient budget allocation in a closed-end manner that requires averaging the treatment budget throughout the country, it will be found that the budget is not enough,” Dr. Wirot explained. “Making it possible to pay compensation at the rate of 8,350 baht/AdjRW, the hospital had to come out and claim because it had an impact.”
Dr.Wirot clarified that the health system’s budget allocation differs for outpatients (OP) and inpatients (IP).Outpatient budgets are allocated on a lump-sum (Capitation) basis, while inpatient budgets operate under a Global Budget (closed-ended budget) system, which doesn’t utilize a DRG (Diagnosis-Related Group) system but relies on calculating relative weight (RW).
“The actual compensation ends with how much is the total closing budget? Then let’s divide it according to the actual expenses, which is often not enough,” he said. “this has made it impossible for many years to pay for inpatient treatment per DRG point at the set rate.”
Thailand’s budget system is likely to remain constrained, Dr. Wirot warned. Policymakers often seek to expand health benefits without increasing the corresponding budget, placing a strain on hospitals and raising doubts about the quality of public health services.
Is increasing funding the only solution to Thailand’s healthcare woes? dr. Wirot believes all stakeholders must acknowledge the need to address the budget shortfall. He also pointed out that the NHSO currently lacks the negotiating power with the government that it once held.
He contrasted the current situation with the tenure of Dr. Sa-nguan Nittayaramphong, the NHSO’s first Secretary-General, who successfully negotiated budget increases with former Prime Minister Thaksin Shinawatra.Dr. Sanguan secured additional funding after demonstrating that freezing the per capita budget at 1,202 baht was unsustainable during the system’s initial years.
Dr. Wirot added that Thailand’s tax collection, currently around 14%-16% of GDP, may be insufficient to support extensive universal welfare programs in the long run. However, he cited the recent adjustment to the social security wage ceiling-a change after a 35-year freeze-as a positive example of necessary reform.
Adequate funding,Dr. Wirot concluded, will restore confidence in the healthcare system. Increased budget support for the “gold card” system and social security would reduce the need for individuals to purchase private health insurance, as they would feel secure in the sufficiency of
