The National Health Security Office (NHSO) plans to significantly boost the annual budget of the universal healthcare coverage scheme, which currently covers 47.5 million Thais, amid growing concerns over its sustainability and calls for reform.
Launched 22 years ago, the scheme is cherished by Thai voters, which explains its survival despite complaints from critics and those responsible for its implementation – mainly state hospitals.
Now the biggest healthcare programme in the country, the universal healthcare coverage scheme (UCS) has also increased its coverage over time, offering most types of treatments – including hormone therapy for transgender individuals – for free.
However, NHSO says it will need a whopping 272.58 billion baht to fund the scheme over the next fiscal year, a 19.51% increase from the current fiscal year, which will end on September 30.
“We need more funds to support new UCS policies, such as allowing beneficiaries to seek treatment at any hospital nationwide, instead of the one assigned to them,” NHSO secretary general Dr. Jadej Thammatacharee said.
However, it remains to be seen if the NHSO’s budget request will get the final green light.
Rising budget and sustainability
The UCS received a budget of 235.84 billion baht from the government for implementation in fiscal 2025, starting from October 1 last year. The total marked an increase of 8.4% from the previous year.
The scheme’s soaring budget has sparked concern that, despite earning wide praise, universal healthcare coverage in Thailand may not be sustainable.
However, Nimit Tienudom, who sits on the NHSO board as a representative of civil society, believes the real threat to the scheme is not a lack of money.
“It’s more about management,” he said.
Better management and overhaul needed
Nimit is doubtful that the UCS budget will be cut, pointing to the scheme’s immense popularity. Instead, his main worry centres on its management, after a series of disputes between the NHSO and hospitals, which have raised complaints about overwhelming workloads and budget constraints worsened by reimbursement problems.
Even top hospitals under medical schools have pressed for more budget to fund their services and salary bills.
“These are major issues we need to address,” Nimit said. “The NHSO must offer a reasonable budget and make sure it is spent efficiently.”
Dr Somsak Tiamkao, director of Srinagarind Hospital under Khon Kaen University’s Faculty of Medicine, called on the NHSO for urgent action to solve problems with the scheme that have snowballed over the past 22 years.
“I can tell these problems are getting close to becoming crises,” he warned.
He also demanded reasonable rates of pay so that public hospitals could increase staff numbers and improve quality of care under the UCS.
Nimit, meanwhile, insisted that the scheme is sustainable, providing the NHSO shows leadership and pushes for more efficient healthcare implementation.
He also urged the Public Health Ministry, which oversees state hospitals, to support the scheme by deciding on reasonable rates for the services provided by participating medical facilities.
What to do with migrant workers?
Nimit dismissed rumours that migrant workers from neighbouring countries are overwhelming public hospitals, threatening the UCS with collapse.
Reports in Thai media claim that hordes of migrants in need of treatment are turning up at public hospitals, which have no choice but to treat them for free.
“The number of such patients is not high enough to threaten the viability of the scheme,” Nimit said, without providing statistics.
He added that the government could easily address the healthcare needs of migrant workers by selling health insurance policies at a national scale.
Currently, it is left up to each individual hospital to decide whether to sell health insurance to migrants. This results in a poor distribution of risk.
“We should consider amending the National Health Security Act to require that the NHSO also manages healthcare for foreigners,” Nimit said. “Simply put, the NHSO should sell annual health insurance policies to migrant workers that cover their entire stay in Thailand.”
Nimit said the coverage should be as good as for Thais, since migrant workers also contribute to Thailand’s economy and society.
“If the NHSO plays a role here, risk distribution will improve. Patients’ access to healthcare will also be better,” he said.
He also pointed out that migrant workers may not want to buy health insurance policies from individual hospitals as they may need to move elsewhere to work, meaning they would lose medical benefits they had paid for.
Healthcare equality
Nimit also recommends merging country’s three major healthcare programmes – the UCS, social security scheme, and medical scheme for civil servants and their family members – onto one national healthcare service.
The first scheme covers 47.5 million Thais, the second 12.85 million, and the third 5.3 million. “A merging of the schemes would end inequality in the country’s healthcare provision,” he explained.
This inequality stems from the significant difference in budget allocation for each scheme.
The scheme for civil servants and family members receives about 20,000 baht per person annually, while the universal healthcare coverage scheme is allocated only around 4,000 baht per head.
Nimit said the government could start by merging the first two schemes, UCS and social security.
“Once we take that step, it will become clear that it is really possible to merge all healthcare under one scheme,” he said.
The merging will enable fairer allocation of government budget, reducing inequality and improving overall services, he emphasised.
NHSO’s stance
Jadej said the NHSO had listened closely to feedback from medical facilities under the universal healthcare scheme and is working to increase the budget and improve the reimbursement process.
“But at the same time, we need to meet the needs of the public. We have increased the scheme’s coverage and benefits in response to not just government policies but also the voice of people,” he said.
Dr. Somsak of Srinagarind Hospital, however, insisted that the NHSO must focus on priorities in its mission, resolving old problems before pushing ahead with new initiatives that might complicate existing challenges.
“I can tell these initiatives are useful, but they can also probably wait,” he said.
