Abstract
This project aimed to generate and synthesise evidence on Thailand’s health financing system in alignment
with the National Universal Health Coverage (UHC) Conference 2025, and to develop policy recommendations
that are responsive to long-term system changes. The study reviewed the health financing situation using the
SAFE Financing framework and conducted research across four dimensions.
The SAFE assessment indicates that Thailand has performed relatively well in terms of sustainability, with
health expenditure as a share of GDP remaining within a manageable range (except during COVID-19).
However, in terms of adequacy, government health expenditure remains below the benchmark level under
normal conditions, while non-government health expenditure remains relatively high (22.2–28.8%), reflecting
continued household cost sharing. Nevertheless, both point-of-service co-payments and the incidence of
households experiencing financial hardship from medical expenses have shown a declining trend. Structural
equity challenges persist, particularly due to the contribution ceiling in the Social Security Scheme and
differences in per-capita spending across the three main public health insurance schemes. In the efficiency
dimension, there remains substantial scope for improvement, including reducing low-value care, strengthening
price regulation, and addressing losses from corruption and system fragmentation.
Health expenditure projections for 2023–2033 estimate that total spending across the three main schemes
will grow at an average annual rate of approximately 6%, outpacing GDP growth and indicating medium- to
long-term structural imbalances. Innovative health financing mechanisms were found to play a
complementary rather than primary role in revenue generation. Co-payments were observed in both
outpatient and inpatient care, while case studies of intermediate care (IMC) and long-term care (LTC) revealed
limited service access and funding gaps, particularly for LTC where actual costs exceed reimbursement rates.
Although the system has not achieved zero copayments in all contexts, there is no evidence of worsening
financial hardship at the population level. Equity analyses reveal disparities across geographic areas and
insurance schemes, with the Kakwani index indicating declining progressivity of health financing, and primary
care resource allocation remaining misaligned with actual workload. Low-value care case studies show
differences in CT/MRI use at the end of life across schemes, sharp expenditure increases in the final three
months of life, and an association between palliative care and lower end-of-life costs.
Key policy recommendations include expanding fiscal space through broader and more efficient tax
collection, earmarking health-harmful product taxes for health promotion, strengthening primary care and
integrated care systems (IMC, LTC, and palliative care), adopting a “zero co-payment” policy for essential and
services with positive externalities, developing a policy roadmap to harmonise the three public insurance
schemes to enhance long-term structural equity, and promoting needs-based service utilisation while
reducing low-value care and minimising inefficiencies in health system resource use.
