Sixty-two public hospitals are facing severe losses, prompting a new inpatient budget allocation divided by health zones rather than a single nationwide lump sum. Research clearly reveals that hospital losses have sharply increased after COVID-19.
Since the COVID-19 pandemic outbreak, public hospitals under the Ministry of Public Health (MOPH) have continuously struggled with liquidity issues, which appear to have worsened over time. This is evident from the alarming decline in overall maintenance funds—for example, comparing the maintenance funds in Q2 of fiscal years 2023 and 2026, based on data from the MOPH's Economic and Health Security Division, reveals a drop exceeding 61.4 billion baht.
Data from the MOPH in May 2026 shows that out of 902 public hospitals under the ministry, 62 are experiencing severe financial crises (levels 6 and 7), an increase of 28 hospitals compared to May 2025, when there were 34 such hospitals.
Although various causes have been suggested—such as budget allocations in universal health coverage systems (Gold Card, Social Security, Civil Servant Medical Benefits) not matching service costs, advances in medical technology raising expenses, and more—no comprehensive, evidence-based overview has been established. Therefore, the Health Systems Research Institute (HSRI) funded researchers from the Health Intervention and Technology Assessment Program (HITAP) to conduct a study titled “Research Project to Enhance the Efficiency and Financial Sustainability of Thailand’s Universal Health Coverage Scheme.” The study aims to fill this gap and develop policy recommendations to directly and effectively address hospital liquidity problems at both policy and operational levels. Preliminary results were presented at a policy workshop organized by HSRI and HITAP on 8 Jul 2026 at the Miracle Grand Convention Hotel, Bangkok.
Dr. Jaravee Sukmanee, one of the researchers from HITAP and HSRI's research network, revealed that the study consists of two parts: 1) identifying causes of hospital financial deficits using quantitative data analysis and qualitative interviews with stakeholders; and 2) developing policy proposals for inpatient (IP) budget allocation by analyzing IP budget data under the National Health Security Office (NHSO) from 2016 to 2025 and reviewing international lessons to guide a new IP budget allocation approach for 2027.
To identify causes, the research team applied Machine Learning to analyze financial data—including total income, expenses, net revenue, and remaining maintenance funds after debt deduction—of public hospitals under the MOPH over 10 years (2016–2025). They used three data groups: 1) hospital income from three main health funds; 2) hospital characteristics and structure, such as hospital level (community, regional, tertiary), bed count, staff numbers, director tenure over 10 years, and number of private hospitals in the province; and 3) service data including total adjusted Relative Weight (Total Relative Weight or TRW) and outpatient (OPD) and inpatient (IPD) service counts.
Dr. Jaravee explained that preliminary analysis shows that from 2016 to 2022, hospitals’ income exceeded expenses, but from 2023 to 2025, income fell below expenses, causing net income deficits in the last three years. Alarmingly, the number of hospitals running deficits dropped from 300–500 between 2016 and 2020 to fewer than 100 in 2022, then surged to 750 in 2023–2025. This aligns with worrying trends in hospital maintenance funds, which increased substantially in 2022–2023 but sharply declined in 2024–2025, resulting in a growing number of hospitals with negative maintenance funds. It is projected that in 2026, up to 600 hospitals will have negative maintenance funds. Total income by the three main health funds remains stable, with income from the Gold Card fund and other sources constituting the main revenue. However, examining only the last three years, about 60% of total hospital income comes from other sources, while income from the three main health funds accounts for only 40%.
Dr. Jaravee added that budget allocation distribution is concentrated mainly in community and large hospitals, with community hospitals receiving the highest budgets annually, though slightly declining recently. Interestingly, private clinics have seen steadily increasing budgets. Factors associated with hospital financial levels include staff numbers, civil servant welfare budgets, and TRW, which increase both total income and expenses. The average adjusted Relative Weight (AdjRW) per admission raises total income by about 39% and expenses by 47%.
Regarding the new IP budget allocation proposal, Dr. Jaravee explained that the research team developed the CARE (Collaborative Area-based Reimbursement with Excellence) Model to allocate IP budgets under the National Health Security System (Gold Card). The key principles are: 1) shifting from a nationwide lump-sum IP budget to allocation by 13 health zones, using historical TRW data adjusted by projected growth rates; 2) after allocation by zone, budgets are adjusted based on service quality—zones with high service volumes but low quality receive reduced budgets. For example, if Health Zone 1 is allocated 10 billion baht but has high hospital infection rates or unnecessary cesarean sections, its budget may be cut to 9.9 billion baht; and 3) a declining unit price mechanism: if a zone’s actual TRW exceeds projections, compensation is paid at a lower rate (e.g., from a 10,000 baht base rate per RW down to 8,000–9,000 baht), while zones with actual TRW at or below projections receive full budget allocation. This approach aims to prevent excessive service provision.
Associate Professor Dr. Jaruwaporn Srisasalak, Deputy Director of HSRI, said that after reviewing information from the workshop, the research team will comprehensively analyze data from various sources to refine and detail policy proposals. The first part of the research results will be submitted to the MOPH to assist hospitals facing deficits and prevent the number of struggling hospitals from rising. The second part, proposing the CARE Model for IP budget allocation, will be presented to the MOPH and NHSO for consideration in hospital budgeting. Both agencies plan to implement this approach in fiscal year 2027, starting 1 Oct 2026. HSRI will monitor and evaluate the effectiveness of the new budget allocation method thereafter.
“HSRI believes that if both proposals are implemented, hospital financial situations will gradually improve, reducing the number of hospitals in financial crisis. Even preventing an increase from 62 hospitals in May 2026 to 70 or 80 would be a significant achievement, as current research forecasts indicate a rising trend in hospitals facing financial crises,” said Associate Professor Dr. Jaruwaporn.
Additionally, a public dashboard website presenting 10 years (2015–2026) of financial data for public hospitals under the MOPH, developed from this research, will be made available to interested parties—especially public hospitals themselves. Each hospital can use this resource as a data base to forecast their financial situations and plan future responses.