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Hospitals in Thailand, which serve nearly 50 million people under the vaunted universal healthcare system, are in dire financial straits. University hospitals such as Siriraj, Ramathibodi and Songklanagarind have reported that the government has still not disbursed last year's medical budget of one billion baht. This has led to major cash flow problems as hospitals face high expenses for wages, medicines and equipment.
Associate Professor Dr. Surasak Leelaudomlipi, chairman of the University Hospital Network (UHosNet), stressed that the budget for the 2023 financial year, which ended on September 30 last year, has still not been distributed. According to him, this is one of the main causes of the financial problems affecting hospitals. In addition, the National Health Security Office (NHSO), which is responsible for administering the universal healthcare system, has long underestimated the true cost of medical services. As a result, there is a major shortage of resources to effectively implement the system.
The NHSO has allocated an annual budget of only 8.350 baht per admitted patient, while the actual costs in government hospitals are around 12.000 baht. In university hospitals, these costs can even reach 25.000 to 30.000 baht per patient. Despite these high costs, the NHSO plans to further reduce the budget per admitted patient to 7.000 baht, which will only increase the pressure on hospitals.
Dr. Anukul Thaitanundr, chairman of the Thailand Regional and General Hospital Society (THS), explained that public hospitals are now forced to seek other sources of funding, including donations, to continue running their daily operations. He emphasizes that the NHSO should consider finding additional resources to finance the care plan, and to stop including the salaries of medical staff in the budget. This would give hospitals more space to continue providing their services.
Another problem is the new policy change introduced by the ruling Pheu Thai party, which allows patients under the universal healthcare system to receive care at government hospitals anywhere in Thailand, instead of just at the hospital they were originally assigned to. While this has improved access to care for many people, it has also caused costs to skyrocket. For the 2024 financial year, the government has allocated only 74 million baht to cover this policy change, while the actual cost has already risen to more than 4,56 billion baht.
Prof. Dr Somsak Tiamkao, a neurologist at Khon Kaen University's Faculty of Medicine, emphasizes that the number of cancer patients in his hospital has quadrupled since the introduction of the new “Cancer Anywhere” programme. He warns that if this policy is further extended to Bangkok, university hospitals there, which already function as tertiary care institutions, could become seriously overloaded.
UHosNet, the THS and other allies have now called for the creation of a 'Provider Board', a council that would oversee the country's healthcare systems. According to Surasak, such a council would provide greater transparency and sustainability, and could act as a balance to the NHSO, which is responsible for purchasing medical services using government budgets.
In addition, Surasak advocates giving patients under the universal healthcare system the opportunity to contribute to additional services themselves, as is the case with other healthcare systems in Thailand. This would not only give patients more options, but also help alleviate financial pressure on hospitals. For example, some patients might be willing to pay for better treatments or luxury upgrades such as private rooms, which are not currently possible under the universal healthcare system.
However, not everyone supports the idea of co-payments. Nimit Tien-udom, who represents non-governmental organizations on the NHSO board, warns that this could lead to greater inequality in care. He argues that hospitals should not focus on profit or loss, but on how they can continue to provide their services within the existing budget.
Dr. Jadej Thammatacharee, secretary general of the NHSO, is willing to hold discussions with hospitals about their financial problems, but insists that hospitals must be prepared to share their detailed budgets. According to him, no hospital has yet made their entire expenditure items available for review.
Surasak emphasizes that while hospitals are not focused on profit, they need sufficient financial resources to develop their staff, equipment and technologies and provide the best care to their patients. However, this is not feasible with the current budgets, according to the medical teacher.
Source: Thai PBS
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Known as Khun Peter (62), lives alternately in Apeldoorn and Pattaya. In a relationship with Kanchana for 14 years. Not yet retired, have my own company, something with insurance. Crazy about animals, especially dogs and music.
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Then they should make the prices 40 baht instead of 120 baht, which will still be too little, but every little bit helps
In Thailand, some 72 million people can get their care from hundreds of state hospitals, dozens of private hospitals, and thousands of clinics. The Ministry of Health supervises the government. The ministry assumes that 99% of Thai people are insured in some way against health care costs. Thailand has a three-tiered organization of health insurance. This includes
1- the group of employees, more than 20 million people: compulsory insurance under the 'Social Security Act' (SSO);
2- the group of civil servants and their families, which amounts to 5 million people: the 'civil service welfare system';
3- almost 47 million Thai people: the 'Universal Coverage Scheme' (UCS) introduced by Thaksin in 2002, known as the '30-baht scheme'.
The said NHSO (National Health Security Office https://eng.nhso.go.th/view/1/Home/EN-US
) is about the financing of that '30 baht UCS'. According to the article, a state hospital needs ThB 12K per patient to be cost-covering. There is only less than ThB 8,5K available. The costs incurred by university hospitals even amount to ThB 30K per patient. Private hospitals that do not participate in NHSO programs naturally focus on those who either pay their own healthcare costs and/or declare them with their health insurer. Of course, the wealthy from groups 1 and 2.
The NHSO wants to cut back to ThB 7K. They want to achieve this by, among other things, reducing hospital visits by introducing home screenings. Also by offering people more guidance with their medication in pharmacies; by setting up online consultations, and by offering more home care. And the NHSO wants to promote that people can more easily go to a healthcare institution in their place of work and not only in their place of residence. To this end, medical data systems must be linked. The entire transition is going slowly, due to the tight budget.
The NHSO depends on how much is allocated to it from the government budget. According to the article, the network of hospitals has decided that it will monitor the flow from the three healthcare systems mentioned more closely, and that it may also ask people who fall under the “3 baht scheme” to make a personal contribution if additional services are needed. and operations are utilized.
Good morning.
I would like to know where I can find official information about the news that Thai people are no longer bound to the hospital of their place of residence. My Thai friend called 2 hospitals in Si Racha to ask if she can go there. She is registered in Kamphaeng Phet. These hospitals do not know anything about this being possible.
Thanks in advance for the answer.
All the information you want can be found on the link I provided to the NHSO in my response to yesterday's article at 10:27 am. If you want to find something you like, you have to search. But I will give you a helping hand: on the relevant site there is an article explaining the rollout of “The “30-baht Treatment Anywhere,” entitled: “Upgrade UCS with neighborhood healthcare model”. It started in January last in 4 provinces: Phrae, Phetchaburi, Roi Et, and Narathiwat. Eight more provinces will be added in the course of this year. They would be: Phetchabun, Nakhon Sawan, Nakhon Ratchasima, Amnat Charoen, Nong Bua Lamphu, Sing Buri, Phang Nga, and Sa Kaeo. This does not mean that the hospitals are already standby and operational in terms of availability. The plan should reach all of Thailand by 8 at the latest. But as the article already indicates, things are stagnating due to a shortage of money, and since a new PT government has not yet taken office, the 2030 budget has already been deployed for the 2025K wallet, and there are at least 10 more projects in the pipeline, it will be wait a little longer for your wife. To help you along the way:
https://eng.nhso.go.th/view/1/DescriptionNews/From-Treats-All-Diseases-to-Treatment-Anywhere-The-Transformation-of-Thailands-Universal-Coverage-Scheme/610/EN-US
I've mentioned it here several times. How can the government provide cost-effective healthcare if many millions of Thais do not pay a cent in taxes.
If the government were to impose a tax on EVERYONE according to their income, then there would at least be a broad base to support health care.
The many hundreds of thousands of illegal sellers along the streets and in the markets, the many small shops that sell goods and services that are not monitored at all, let those people make a small contribution. They want virtually free medical care, but FREE simply does not exist.
Now I expect another series of reactions that you cannot expect that contribution from people who earn next to nothing. “Earning nothing” is a relative concept, which is often used to avoid having to pay taxes. Every little bit helps, even those of the so-called poor people. I don't know the official figures for black trading, but I think they are extremely high.
My sister-in-law sells ice-cooled Thai desserts further down the street, completely in black. She starts her work just before noon and returns home at 19 p.m. Not an extremely long working day by Thai standards. I hear from my wife that she has an average turnover of 1000THB/day, sometimes double that during the weekend. Just calculate on a monthly basis. I think they can ban such trade. Complaining about not having to pay anything is all too easy.
Louis, you say that lady sells a thousand baht a day. But turnover is not income! That's where purchasing and costs have to go. What is left then? Any ideas?
Someone who has income can withdraw something from it before he has to pay taxes. Sixty thousand baht per year as a personal exemption, 150.000 baht as the first bracket at zero percent, deduction for dependent children, possibly the old people, and more. That's almost 20k baht per month and do you really think they earn that net from selling a drink or dried fish?
No, I think you want to target the poorest people again. And 'black market' as you call it, what would you do if your country has no social safety net, no WIA and WW, and you have a house with hungry children? Then you start pounding; you too!
Your premise is also wrong. Cost-covering care, do we have that in the EU? You know as well as anyone that 'care' is one of the largest costs in the national budget. This is no different in Thailand and, in my opinion, rightly so.
No, take the money where it is. And a start was made on that this year.
Actually, I don't feel like responding to this because if you say something here, it will always be undermined by the same people. But this is called free speech.
That lady, my sister-in-law, sells her desserts for 30d/month.
Her expenses are only the basic products she purchases. My wife knows from her sister that she keeps more than 50% of the turnover.
If I can calculate correctly:
30 days x 1000THB/day = 30000THB
Weekends: another 4 x 2000 = 8000THB
Her turnover is therefore 38000 THB
Her winnings 19000THB/month (probably even more because in the hot summer months she can't keep up with demand)
On an annual basis: 12 x 19000 this is 228000 THB on which she pays no taxes!
My wife used to work in the production department of a dirty factory for a pittance of 10000 THB. And this more than 8 hours a day.
You do what you want with it. And there are many like my sister-in-law.
For the rest, you should not expect any further response from me.
Louis, there is a discussion happening here! You have to be able to handle that.
Good; Mrs. earns 228.000 baht per year. Quite possibly 210.000, so taxed 18.000 baht at five percent.
“Your premise is also wrong.”
Well, such assumptions are not up for discussion, apparently everything that is mentioned is wrong.
A good example of imposing your own opinion.
If I understand Louis's reaction correctly, the woman in question does not pay taxes, or am I reading it wrong? And you think it is okay that you cannot touch a black monthly salary of 18000THB. Nice discussion.
Dear Erik,
I totally DO NOT agree with you. In addition, you insinuate that Louis hits the poorest in the wallet. Where is that?
Louis doesn't write that at all. I think people who only earn 8-10000 baht should be left alone, but there are plenty of Thais who earn a lot more and are proud of NOT paying taxes. Fact.
Dear Louis,
I wouldn't worry too much about it.
We also have a similar case here in the family. They brag that they don't have to pay taxes, but they still have a well-run business. That person has even had to get some help during the weekends.
All this is turned a blind eye. If there were proper controls on undeclared work, many would be surprised. But then the government should not complain that financial care is becoming unaffordable.
Erik,
Now you're really beating around the bush.
No, in Thailand there is no cost-covering healthcare, that's what this topic is about. What happens in other countries is irrelevant here and is off-topic.
The big question is of course WHY there is no adequate social safety net. And Louis above has a point there. Greater state wealth in itself would solve many of the problems and this can be done by, among other things, a fair tax on labor.
I have been living here for 17 years now and know the Thai people inside and out. Everywhere you go people pride themselves on avoiding any form of control as much as possible. Undeclared work is considered very normal here.
Another major cause of a lot of poverty among the population is not only a lack of income but overconsumption. A bigger house, a big car in front of the door and a lot of debts to the bank. And then people are surprised that they end up in poverty. Many Thais themselves are the cause of their misery. And yes, then people complain afterwards that paying taxes is not for them. Actually the upside down world.
Frits, may I have a different opinion than Louis? I view the lack of a social safety net differently than some other writers. Fine, we can put up a tree about that.
The reported possible tax fraud is not typically Thai...
But Louis complains that someone has a different opinion. 'Then I won't respond anymore' and so on. That's fine, but what do you do in a discussion blog? Moreover, he miscalculates that lady's tax obligations.
This item is about the financing of state hospitals. I can't imagine that those gaps can be filled by taxing 900 baht per year on people who do something...
Dear Louis,
I can certainly agree with your story. This black market, no matter how big or small it is, is a real plague in Thailand.
I have a fairly large Thai family and there are quite a few who have an extra income. I have 2 nieces, among others, who both work for the government and sell their stuff at the market every evening and at weekends after their day job. None of this is indicated.
The amounts will of course not be super high, but I also think the principle itself is wrong. If you start working, you must pay taxes in proportion to your income. Those 2 nieces may not benefit from that 30THB health care, but there are certainly many others.
Dear Andre, if you work for the government, the entire family is not insured through the government, then they are not eligible for the 30 bath scheme, I think.
Aad, an extremely strange reaction on your part. Even Belgium does not have a cost-covering healthcare system. A prosperous, sophisticated country, it is said. And averse to taxes. Hence a mediator. But we are talking about Thailand: someone who has a net income of 30K per month, single, pays ThB 2500 per year in taxes after deduction of tax credits. If your sister-in-law also has the care of a parent or child, the levy is nil.
I want to give you some more facts:
1- According to a report by the Bank of Thailand, as many as 45% of Thai workers work in the informal sector. In the Netherlands this is also called undeclared work. This is work that is not officially registered and is therefore not taxed. People who work undeclared in Thailand are not under contract and therefore do not have the same rights as employees in the formal sector. They are not affiliated with the SSO, do not receive old-age benefits, and are excluded from opportunities and possibilities.
2- The fact that so many people work in the informal circuit/undeclared work means that unemployment in Thailand is remarkably low and is only 1,64%. According to the Organization for Economic Co-operation and Development (OECD), unemployment in the Netherlands is comparatively 3,8%. The Netherlands therefore has more unemployment than Thailand, although both countries score excellently in this area. The Netherlands is such a rich country, isn't it?
3- According to the World Bank, the GNI per capita in Thailand is €514 per month. In the Netherlands, the GNI per capita is €3.731 per month.
4- According to the latest figures from the World Bank, Thailand has a score of 36,4 on the Gini index. The Netherlands has an index score of 28,1. Income inequality in Thailand is therefore much greater than in the Netherlands. This inequality in Thailand partly explains why so many people rely on the informal circuit.
It is sad to read that no less than 45% of the Thai population is employed in the undeclared work circuit. I had no idea about this, but it is huge.
Some above even think this is normal and tell us that we should stay out of those people's wallets. Then my explicit question is how you can set up a cost-covering healthcare structure if only 55% of the population pays their taxes.
I think a serious change in mentality is required here. Then it is possible to get out of that vicious circle.
On the other hand, I have the impression that many Thais would rather go through life poor than tired. They just muddle through and see how far they jump at the end of the month. You won't get anywhere in life that way. But then they still want to fall back on the goodwill of the government. That's not how it works, is it?
Indeed, impressive figures, that surprises me.
And that about that lazy Thai, haha you have a point there.
I live in a village in the middle of Isaan and not much work is done here 🙂
The little work in the fields is still usually done by poor poor people from Laos.
Working in the informal circuit is not the same as working undeclared.
Up to an income of 150.000 Baht per year, a Thai does NOT have to pay income tax. That is NOT the same as working illegally at all. About 45% of the population works for themselves (small independent: farmer, street vendor, lottery seller, mobile shop) or has irregular work (and works on daily wages) or works on commission (e.g. insurance agents). That is also not working illegally because most do not reach the 150.000 Baht income per year.
That working illegally, which it is not, does not cause the low unemployment figures. That low percentage is the REGISTERED unemployment. I.E.: the Thai who have reported to the employment office because they have no work (anymore). However, most unemployed people do not do that because it has no advantages or disadvantages. There is no unemployment benefit and you simply get NOTHING when you are unemployed.
Income and wealth inequality is high in Thailand. Cheap care is therefore essential for many Thais. The daily cost of living is already high enough. It has been discussed here before that Thailand, as an upper middle-income country, comparable to the Netherlands in the 50s, could well afford a better social safety net. But that also requires skimming money from those who can easily afford it. All Thais pay taxes (think VAT) so there is no Thai who lives entirely on income or someone should know a Thai who lives/survives 100% self-sufficiently somewhere...
If the current safety net does not function sufficiently, and I believe so, see also articles about income and informal economy by Tino earlier on this blog, then something needs to change at the base. But that of course hurts the families from the upper classes. Comparable to how in Europe and elsewhere workers/peasants had to fight with considerable pressure and sometimes considerable violence and misery for a different distribution of the pie. Saying yes and amen and listening to the people high up on the mountain will not solve social problems by themselves...
It is not the case that 45% work in the undeclared area, but that they simply fall below the threshold for having to pay tax. That example of B200.000 per year is in my opinion the big exception, by far most earn under B10.000 per month. As soon as someone starts selling more, privateers come to the coast and start the same business. In recent years it has mainly been coffee bars and pizza restaurants here in the area, you see one and a few months later they spring up like mushrooms.
My daughter-in-law has a sort of postal agency, earns a few thousand baht a month sending various items of mail and parcels, she expects her earnings to decrease even further as a similar mailing company has recently started in the next village.
The costs of collecting taxes from these types of companies never outweigh the benefits