The Permanent Secretary of the Ministry of Public Health affirmed that no one intends to abolish the “gold card” scheme but reforms are necessary to close loopholes after state hospitals suffer heavy losses and face bankruptcy risks in the future. Budget allocations are misdirected, with an expansion of numerous small subsidiary funds, resulting in insufficient treatment budgets.
On 4 August 2026, Dr. Somruk Jungsaman, Permanent Secretary of the Ministry of Public Health, spoke about proposals to reform the health insurance system. He confirmed that no one plans to abolish the 30-baht gold card but stressed the need for reforms to close loopholes to prevent system failure from budget crises and to ensure the health insurance system is effective, stable, and sustainable. The main causes include:
1. State hospitals are facing a liquidity crisis, with many currently suffering heavy losses and negative budgets impacting patient services—for example, reducing medication supplies from 2–3 months to just 2 weeks or switching drug brands. Overall hospital maintenance funds have dramatically decreased from 60 billion baht to only 15 billion baht. Without prompt action, some hospitals may face bankruptcy within a few years.
2. Problems in the mechanisms and governance of the National Health Security Office (NHSO), including monopolies on board positions, with some members serving since the office’s establishment in 2003, rotating between the NHSO board and quality control board. Important benefits have been cut, such as the removal of the childhood IPD vaccine citing economic inefficiency. Budget allocations have been misdirected, focusing on secondary services like innovation clinics, while budgets for critically ill patients remain insufficient.
Acknowledging the system’s problems is the first step toward cooperation to fix them so the gold card can truly serve the public. The Ministry of Public Health proposes six reforms:
1) Increase budget allocations to adjust treatment fees to reflect actual costs.
2) Prioritize public health problems, focusing on efficient and cost-effective budget use.
3) Establish a fund to manage primary healthcare systems under the Primary Healthcare Act, ensuring all citizens have access to disease prevention and health promotion.
4) Build a strong governance and transparent oversight system, especially regarding the appointment of boards and subcommittees.
5) Halt the addition of new benefits or subsidiary funds without clear budget support.
6) Separate public health personnel salary budgets from the capitation payment budgets of the gold card fund.
These measures aim to ensure transparent and good governance management of the health insurance fund, while guaranteeing that all citizens receive sustainable health promotion, prevention, and treatment services.