The Comptroller-General’s Department is preparing legislation to control medical coverage expenses for civil servants and their families, as spending on benefits continues to accelerate.
In fiscal 2026, the government allocated a budget of 94.2 billion baht for medical welfare. In the first nine months of the fiscal year to June 30, 94 billion baht was disbursed, said Patricia Mongkhonvanit, the department’s director-general.
Spending is expected to exceed 100 billion baht for the fiscal year ending in September, attributed to Thailand’s ageing demographics and the improper use of benefits by some members, she said.
The Civil Servant Medical Benefit Scheme covers about 4.9 million people, including current and retired civil servants, other state employees, their spouses and families. Average annual per capita spending under the programme is about 12,000 baht.
By comparison, the figure for coverage of roughly 12 million private-sector employees under Section 33 of the Social Security scheme is about 7,100 baht. The Universal Coverage or ‘gold card’ scheme, which covers 75% of the population, is around 3,400 baht per year.
Recent public hearings found that most respondents supported strengthening governance in reimbursing medical expenses and establishing shared responsibility among family members.
According to a proposed royal decree being drafted by the department, if any family member violates the rules governing medical reimbursements, the benefits of the entire family are suspended.
This approach is intended to encourage family members to monitor one another, said Mrs Patricia. If their government medical benefits are suspended, they can still receive treatment under the 30-baht universal coverage scheme. (Story continues below)
Four proposals
Stakeholders were invited to comment on four issues during the drafting of the legislation.
First, mechanisms are to be established requiring healthcare facilities to adopt effective reimbursement policies and measures based on good governance principles. Eighty-nine percent of respondents agreed with this proposal.
Second, the responsibilities of eligible beneficiaries regarding family members’ use of medical benefits need to be clearly defined, which 68.6% of respondents supported.
This proposal would allow members to choose which family members, such as a parent or spouse, may use their medical benefits.
In practice, there have been many cases in which civil servants have personal disputes with family members and do not wish to extend benefits to them, noted the department. Family members previously had no alternative for basic healthcare coverage, but now they can utilise the 30-baht healthcare scheme.
Third, an entire family’s medical benefits are suspended if one member commits a violation. Around 60% of respondents supported this measure, which is intended to promote shared responsibility and encourage family members to monitor one another.
Fourth, healthcare facilities are required to register with, and process direct reimbursements through, an electronic system. Three facilities have yet to join this system, but only 54% of respondents supported this proposal.
However, 53% of respondents disagreed with the proposed amendments to the legislation. The department believes this may be a misunderstanding that the changes would reduce or remove medical benefits.
The amendments are not intended to reduce benefits, but rather to improve transparency, Mrs Patricia said.
The amendments are expected to be proposed as a royal decree to fast-track adoption after public hearings and submission to the cabinet, in a bid to ensure state spending is as efficient as possible. (Story continues below)
New guidelines
To ensure sustainable control of expenses, the department is preparing new operational guidelines.
The first guideline promotes the use of generic drugs as the first option before resorting to brand-name drugs, reducing medication costs.
The markup criteria for medicines and hospitals’ medication management fees are also being revised.
The department is preparing to abolish the current rule allowing healthcare facilities to add a 10% management fee to all types of medicines. Instead, the markup is adjusted according to the type of medicine.
In addition, controls are being tightened on weight loss/diabetes medications. More conditions cover reimbursement of diabetes drugs that have a side effect of promoting weight loss, which are becoming more popular.
Such drugs must be prescribed by a specialist, with clear procedures governing their use.
Another guideline reduces duplicate laboratory tests, intended to prevent patients from undergoing repeated blood tests or lab examinations when they change hospitals. Patients’ treatment histories are to be linked, with appropriate intervals established for each type of test.
Finally, the revisions address fraud involving the diversion or resale of medicines. Clear procedures are expected to cover investigation and penalties, ranging from warnings to temporary suspension of healthcare benefits.
Mrs Patricia said spending on those aged 60 and above is driving the increased expenses. This group accounts for around half of all eligible beneficiaries and often incurs high medical costs towards the end of life.
Another factor is the treatment expenses for the 10 most prevalent non-communicable diseases, which account for more than 40 billion baht in drug costs.
As of the end of July, there were 4.89 million eligible beneficiaries under the scheme, comprising 2.3 million principal beneficiaries, or 47.2%, and 2.6 million family members, or 52.9%, according to the department.
Emergency medical service officers demonstrate how to safely transfer a victim to medical facilities in an emergency situation. Spending on government officials’ welfare benefits has continued to rise in recent years, due partly to Thailand’s transition into a fully aged society and partly to the improper use of medical benefits by government officials.