NHSO blamed for public hospitals developing over 4bn baht budget deficit
Senior doctor blames NHSO underfunding for public hospitals' 4.2bn baht deficit, warning of worsening liquidity crisis under the 30-baht scheme.
A senior doctor has alleged that the National Health Security Office (NHSO) has underpaid hospitals operated by the Public Health Ministry, leading to accumulated losses of over 4 billion baht as of the first quarter of this year.
Dr Anukul Thaithanandorn, former president of the Thailand Regional and General Hospital Society, claimed that the NHSO allocated insufficient funds for public hospitals to care for approximately 40 million patients under the 30-baht universal healthcare scheme.
This underfunding, he said, caused a liquidity crunch and a total budget deficit of 4.219 billion baht by the end of Q1 2025.
Hospitals With the Highest Deficits
According to Dr Anukul, the top 10 public hospitals with the largest deficits are:
- Khon Kaen Hospital: 848.32 million baht
- Chaiyaphum Hospital: 180.02 million baht
- Ayutthaya Hospital: 147.45 million baht
- Ranong Hospital: 123.49 million baht
- Phang Hospital, Chiang Mai: 117.77 million baht
- Ban Mee Hospital, Lop Buri: 113.84 million baht
- Phetchabun Hospital: 108.08 million baht
- San Patong Hospital, Chiang Mai: 102.92 million baht
- Phra Phuttabat Hospital, Saraburi: 102.12 million baht
- Pak Chong Nana Hospital, Nakhon Ratchasima: 73.28 million baht
Dr Anukul revealed these figures during a recent seminar on the 30-baht universal healthcare scheme, jointly organised by the hospital society, the Society of Clinics, and the University Hospital Network at Rama Gardens Hotel.
Funding Gap Due to DRG Undervaluation
Dr Anukul explained that the Adjusted Relative Weight (adjRW)—a unit used to calculate healthcare funding based on Diagnosis-Related Groups (DRGs)—was calculated by hospitals at 13,000 baht, yet the NHSO only paid 8,350 baht per adjRW, and in some cases as low as 7,100 baht when budgets were tight.
DRGs are a classification system that groups patients by diagnosis and treatment type. Each group is assigned a Relative Weight (RW), representing the average resources required for treatment.
The low payments, he said, directly contributed to the financial shortfalls experienced by public hospitals.
218 Hospitals Operating in the Red
As of March 2025, 218 public hospitals were operating at a loss after receiving NHSO payments based on the adjRW model. A further 91 hospitals had less than 5 million baht in available funds.
The situation worsened in April, when 82 hospitals had not yet been reimbursed for 119 million baht in medical expenses.
Uneven Budget Allocation Criticised
Dr Anukul further criticised the NHSO for limiting budgets for public hospitals that actively treat patients, while allegedly allowing drugstores and private clinics to freely claim reimbursements for medications and minor treatments under the "30-baht anywhere" scheme.
