In recent months, a war of words between the National Health Security Office (NSHO) and the director of privately owned Mongkutwattana Hospital, Dr Rienthong Nanna, has given the public a glimpse into how the universal healthcare scheme is run, reports the Bangkok Post.
Citing a long-overdue payment of about B100 million from the NHSO, Dr Rienthong says his hospital will suspend medical services to outpatients holding B30 healthcare cards, under the so-called gold card scheme.
The Ministry of Public Health, meanwhile, admits many hospitals under its responsibility have run up an accumulated deficit of about B18 billion, as expenditures are 110% higher than revenue.
These hospitals have asked the ministry to provide a short-term solution by approving B8bn from the the central budget to continue running the scheme.
Medical staff have also called for the NHSO reform. Their call is echoed by hospitals, clinics and community clinics that are the NHSO’s major partners.
Dr Pawinee Eamchan, director of Saraburi Hospital and chairwoman of the regional hospital and general hospital club, said hospitals are at the healthcare frontline and have an obligation to treat patients regardless of budget constraints.
“The gold card controversy is a pressing issue and will have a big impact on the national healthcare system if it is not fixed,” Dr Pawinee said.
“Now, we can still provide services because of money from people’s donations,” she said.
Saraburi Hospital’s account has been in the red, running a deficit of over B120mn. Delayed payment, insufficient budget and the expansion of medical services to provide patients with advanced medicine and medical treatment have caused a financial crisis.
The NHSO’s budget allocation to hospitals is calculated using AdjRW (Adjusted Relative Weight) and is based on a per-head formula.
Currently, NHSO allocates B8,350 per head, which is significantly lower than the actual average cost at B13,240.
The per-head rate is even lower than B7,000 in some hospitals when NHSO applies a new regulation allowing for backward calculation, or the so-called re-run system, from the period of Oct 1, 2024, to July 31, 2025.
Some state-owned hospitals have opted to provide second-tier medical treatment and even alternative drug prescriptions to cope with limited budgets.
Medical groups have demanded cancellation of the rerun system and called for a new fund for in-patients to compensate for the loss from AdjRW.
Under the fiscal budget for 2026, the government approved B265.30bn for the national health security fund, which is divided into B198.23bn for care for 47.5 million gold-card holders, a B16.38bn increase from last year.
The remaining B3.8bn is allocated to local administrative organisations, B27.76bn to the disease prevention and promotion scheme, B4.6bn for Aids patients and B16.08bn for patients living with kidney diseases.
Just B562.22mn is allocated as an emergency fund for health providers, however.
NHSO is now under heavy criticism, especially from medical service providers who are unhappy with its performance and say the office often ignores them.
They have called for more medical service providers to sit on the NHSO’s committee. Currently, there is only one. Medical service providers should be treated as a trusted partner by the NHSO, not as “a boss and an employee”, said one medical service provider.
Without providing sufficient financial support to medical service providers, NHSO and the Ministry of Public Health will be blamed for poor healthcare services and possible mass resignations of medical staff from state-owned hospitals.
Thais under the gold-card scheme will be the ones who suffer from such poor management, said one medical staff member.