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Conflicts in the Thai health system: NHSO fights for the budget!
Insight into the long-running conflict between NHSO and Thai hospitals over healthcare funding and its impact.
Conflicts in the Thai health system: NHSO fights for the budget!
The current focus in Bangkok is the long-running dispute between the National Health Security Office (NHSO) and the hospitals that care for patients under Universal Health Coverage (UHC). This problem has existed for more than 20 years and dates back to the former "30 baht for each illness" policy. The causes are complex and range from operational challenges to structural problems within the healthcare system. So reported Hfocus, that the NHSO serves as public health insurance for about 70% of the Thai population, while other institutions cover the remaining 30%.
The role of the NHSO is crucial because they determine which healthcare services are reimbursed. This puts them in a monopoly-like position as they are the largest buyer of healthcare services in Thailand. Conflicts in the system are inevitable, especially when resources are limited. The NHSO's budgeting is also based on estimates, which often leads to financial bottlenecks. In the past, NHSO has had to reduce reimbursement rates, causing discontent among hospital management.
Unity is inevitable
A press conference was held on November 4, 2025, at which Health Minister Pattanapong Pattharaprasit and other officials announced an agreement on the 2025 budget. The minister sent a clear message: cooperation between the Ministry of Health and the NHSO is essential. Within this framework, the “30 baht for all treatments” program remains in place. Loud INN News The budget for inpatients in 2025 has already been clarified, with payments per case remaining constant at 8,350 baht.
In order to avoid future conflicts, special features in budget management were also introduced. The five budget categories – outpatients, inpatients, health promotion, fees and project-based management – will be managed together in the future. In addition, transparency should be improved by separating the salaries of health workers.
A look into the future
The NHSO also has proposals to review healthcare services that are not cost-effective. This could be a solution to sustainably address the challenges in the healthcare system. The idea of cross-subsidization between the different insurance systems could be further organized at the government level to minimize the financial burden on hospitals. With a budget for 2026 managed jointly between the Ministry of Health and the NHSO, the course appears to be set for positive developments.
The overall goal remains to create a balanced and sustainable healthcare system in Thailand in which resources are used optimally and all citizens have access to healthcare. The future of the healthcare system is not just a question of finances, but also a concern for the health of society. The coming months will show whether this entire process brings the desired results.