A forum opened to discuss proposed amendments to the Gold Card Act, with consensus that problems like hospital budget shortages, staff fatigue, and long patient waits should be addressed through management and service system reforms rather than overhauling the law. Attention focuses on four risk points that may affect health rights.
On 4 Sep 2026 GMT+7, reporters reported that on the evening of 3 Sep 2026 GMT+7, the Consumer Council hosted a discussion forum. "Spotting the Signal! Amending the Gold Card Law = Ending the 30 Baht Scheme, Regressing to a Destitute System?" The forum exchanged views on proposals to amend the National Health Security Act, known as the Gold Card, amid concerns that legal changes might affect both citizens' rights and key mechanisms of the Gold Card system. Representatives from civil society, academics, and health experts agreed that issues such as hospital budget deficits, overburdened staff, and service overcrowding should be resolved through better budget management and service system efficiency rather than legal amendments that might undermine public health guarantees.
Highlighting 4 risk points in the legal amendments.
Ms. Kannika Kittivechakul, Deputy Chair of the Local Health Security Committee, said the forum's purpose was to spotlight four key concerns: opening the door for patients to pay extra fees upon treatment, risking access based on ability to pay; reducing civil society’s role on the Gold Card committee; increasing the minister’s authority to direct the NHSO; and allowing fund money to cover hospital operating costs like salaries, utilities, or construction, which might reduce budgets for patient care.
Ms. Kannika emphasized that any legal amendments must not roll back citizens’ health guarantees. Everyone should receive standard, equal services without fees that hinder treatment. Civil society must have genuine participation in decisions, and the Gold Card fund must be used primarily to provide health services to the public.
Amending the Gold Card Act is not the answer.
Dr. Supat Hasuwannakit, former director of Sabayoi Hospital, stated the health service system currently faces three main issues: 1) hospitals receive insufficient budgets for their workload; 2) medical personnel are exhausted due to increasing patients, especially as Thailand becomes an aging society with more chronic illnesses; and 3) patients endure long waits and sometimes receive diminished services.
Dr. Supat believes amending the National Health Security Act, or Gold Card Act, is not the solution because it does not increase hospital budgets, reduce medical staff burdens, or shorten patient wait times. He likened it to "prescribing the wrong medicine for the wrong illness," noting the current law already balances power among providers, the government, and civil society.
Recommendations to reform the service system.
The recommended solution is to "reform the entire health service system" before adjusting budget allocations accordingly. He proposed developing a family doctor system or Smart Family Clinics to divert outpatient cases from large hospitals, reducing overcrowding and freeing space for inpatients. Alongside, improving home-based end-of-life care would reduce critical care ICU bed use, lower hospital costs, ease staff burdens, and enable faster patient access. He urged political parties to adopt these concepts into clear health policy.
If Thailand can reorganize its health service system, it will more effectively solve problems than amending the Gold Card Act, by lowering hospital costs, reducing medical personnel fatigue, and shortening patient wait times.
Amending the wrong aspect risks destabilizing the health system.
Mr. Nimit Thianudom, a National Health Security Committee member, said one key issue in the proposed amendments is restructuring the committee managing the fund of over 270 billion baht annually. The proposal to add nine provider members while reducing experts and civil society representatives might alter the existing checks and balances. For over 20 years, central fund management has had no corruption record. He also noted that the Ministry of Public Health does not hold sole bargaining power, as it is the main service unit and already receives most Gold Card funding.
Another concern is redefining citizens’ rights as "basic benefits." Mr. Nimit warned this could shift the system from generally covering treatments except specified exclusions, to defining which services are basic rights and which are excluded. This may limit access to some treatments and pave the way for co-payments, increasing patients’ financial burdens.
Mr. Nimit stressed the National Health Security system plays a vital role in enabling access, reducing inequality, and protecting households from catastrophic health expenses. If current problems stem from management or budget allocation, fixes should target administration rather than legal changes that risk citizens' rights and system checks and balances.
Calls to overcome political conflicts.
Mr. Athikkit Saengsuk (Bai Tong Haeng), a journalist, columnist, and political analyst, viewed that health security problems are not solely budgetary but linked to long-standing structural conflicts among the Ministry of Public Health, the NHSO, and medical personnel. Workloads for doctors, nurses, and staff have risen due to patient numbers, aging society, and delayed welfare or pay, increasing systemic strain.
Athikkit also noted issues with budget management under the “treat everywhere” policy and medication services at pharmacies. While aiming to reduce hospital overcrowding, using the same budget pool makes some providers feel their budgets shrink. He highlighted concerns over irregular claims data and conflicts over auditing, observing that the NHSO has limited bargaining power since it owns no service units and relies on many public hospitals and private clinics to serve the public.
Regarding sustainability, Athikkit said the Gold Card fund, covering tens of millions of people, must operate under a capped budget and use medical resources efficiently. It cannot be an open-ended system with unlimited payouts. He warned that increasing provider power through legal or administrative changes might undermine fund stability long-term. He urged all parties to overcome past political conflicts and jointly uphold the system’s principles for sustainable public care.
Reaffirming the three pillars of the Gold Card.
Mr. Wiroj Lakkhanaadisorn, deputy leader of the People's Party for Special Affairs, said the current amendment process should be closely watched from the start. He views the Gold Card as a national issue affecting citizens throughout life. Hospital deficits or budget shortfalls can be resolved without legal changes by adjusting budget calculation formulas between the NHSO and the Budget Bureau to match workload, allowing the NHSO board to prioritize funding as needed.
He said the system's "three pillars" must be preserved: confirming equal access to health services as a right, not state welfare; having service user representatives to balance and oversee providers; and fair budget allocation based on population and responsibilities, preventing a return to patronage-based budgeting.
Wiroj believes differing opinions and debates in the board are normal balancing mechanisms to protect public interests.
On co-payment proposals, Dr. Wiroj cautioned these must be distinguished from the original fixed 30-baht fee. Dividing services into "basic rights" without fees and "additional rights" with co-payments might halt development of basic services while pushing new drugs, technologies, and treatments into pay zones, limiting access for some groups and reducing doctors’ ability to choose optimal care.
Risk of people falling out of the treatment system.
Ms. Yupa Sukruang, chair of the Thailand HIV/AIDS Network, shared concerns as a service user representative. She stressed the current Gold Card system allows access without financial worry and includes appropriate civil society oversight on the committee. She sees no need to amend laws in ways that reduce rights or increase burdens on patients, especially those with chronic illnesses and lifelong HIV treatment.
Ms. Yupa warned that even partial co-payments could become cumulative burdens for patients needing monthly medication, forcing some to reduce doses or make frequent trips to spread costs, affecting income and daily life. More worrisome is that some patients might stop or miss treatment, leading to drug resistance and broader public health impacts.
She questioned how narrowly "basic benefits" would be defined. If the system focuses only on keeping patients "alive" without quality of life, patients might lack access to new drugs and therapies that reduce side effects and improve well-being. She emphasized that any changes must not diminish patients’ voices or existing rights.
Gold Card must preserve treatment rights.
Ms. Saree Ongsomwang, secretary-general of the Consumer Council, said the National Health Security system arose not from a single political faction but from a "triple alliance" of 11 civil society networks proposing the law, academics studying financial feasibility, and politicians enacting it. The system’s key achievement is enabling people to seek hospital care when ill without worrying about immediate money.
She noted that abolishing the 30-baht fee previously stemmed from administrative cost concerns, as collecting fees increased hospital paperwork and generated insufficient revenue. She opposes returning to point-of-service charges, especially co-payments, which would limit access for those without money. She cited complaints of patients asked to pay 15,000 baht before surgery and delayed treatment if unable to pay, reflecting risks of a system where economic status dictates care timing.
"If the state wants more funds for health security, we can discuss collecting through taxes or health levies so people contribute before falling ill. But charging fees when people arrive at hospitals is unfair since they cannot choose to be sick or not. We must preserve the right to necessary health services as a human right, not reduce it to ‘basic benefits’ requiring extra payment for better care," she said. The Consumer Council secretary-general stated this.