Thailand is considering cross-border health insurance requirements for foreigners as financial pressures mount on border hospitals that report rising levels of unpaid medical bills and, in some cases, difficulty paying staff. Public Health Minister Pattana Promphat said the ministry is developing policy options that would require foreign nationals entering Thailand to contribute more directly to the cost of healthcare, likely through additional health insurance arrangements or premiums.
“We are developing a policy to look at various insurance and health insurance arrangements, to require foreigners entering Thailand to pay additional health insurance. The format will be announced later,” Pattana said in an interview on March 31 at the Public Health Ministry, as reported by The Nation. The proposed measures are intended to address growing funding gaps in hospitals serving border populations, while also informing how insurers, reinsurers, and employers consider coverage for cross-border care.
Pattana said hospitals along Thailand’s borders have been treating a steady flow of patients from neighbouring countries, including people affected by fighting, disease outbreaks, and residents of refugee camps where international support has been reduced. These facilities have been incurring costs for services provided to non-Thai patients, he said, with limited avenues to recover those expenses from individuals, foreign governments or international organisations.
Pattana cited Umphang Hospital, near the Thai-Myanmar border, as an example of financial strain. The hospital recently reported that it did not have enough funds to pay personnel. “After learning that Umphang Hospital was facing a financial crisis and had no money to pay its personnel, I discussed the matter with the permanent secretary of the Public Health Ministry and confirmed that budget support would be provided so that patient services can continue without interruption and medical personnel receive the compensation due to them for caring for patients,” Pattana said.
To manage such pressures, the ministry has implemented a “One Region One Province One Hospital” structure, under which larger provincial hospitals support smaller or financially stressed facilities. In Umphang’s case, hospitals in the surrounding area provided donations, including THB10 million from Mae Sot Hospital and other contributions of THB5 million and THB10 million. Pattana said that across the country, hospitals under the Public Health Ministry provide services to foreign and migrant patients but are unable to collect several billion baht a year, making this a national fiscal issue rather than a problem confined to border regions.
Uncollectible healthcare costs in border areas were about THB1.894 billion in 2019 and THB1.763 billion in 2020, before rising to THB3.514 billion in 2021 and THB3.597 billion in 2022. The figure then declined to THB2.054 billion in 2023 and was around THB2.315 billion in 2024. For 2024 (as of Feb. 28, 2025), the Thai-Myanmar border accounted for 76.3% of uncollected costs, with roughly 570,000 service visits by foreign nationals generating THB1.8 billion in unpaid bills. The Thai-Cambodian border represented 12% (160,000 visits; THB277 million), the Thai-Lao border 7.8% (100,000 visits; THB180 million), and the Thai-Malaysian border 4% (41,000 visits; THB93 million).
The ministry is now examining how much public system capacity should be reserved for Thai nationals and how much can be allocated to foreign or cross-border patients, acknowledging that each border area faces different patterns of demand. Pattana referred to a resolution of the 18th National Health Assembly that proposed establishing a dedicated fund for foreign patient care, initially capitalised with THB100 million to THB200 million of government funding, followed by potential contributions from civil society and other sources.
Pattana said any such mechanism would need to be evaluated alongside Thailand’s broader budget priorities and its international relationships. “If the funding is intended to cover care for foreigners, that would need to be considered separately, while care for Thai people is already part of the ministry’s mandate,” he said. He added that he does not want short-term measures to be used for what he views as structural issues of financing and responsibility. Proposals to adjust the allocation and management of the universal coverage “gold card” budget and to reform the National Health Security Office (NHSO) remain under discussion, with what he described as gradual progress and ongoing consultation.
Thailand’s review of cross-border health funding comes at a time when medical costs in Asia-Pacific are rising faster than global averages, influencing insurer pricing, underwriting, and benefit design. Data from WTW show that gross medical trend in Asia Pacific was 11.8% in 2024 and is expected to reach 13.2% in 2025, with a projection of 14% in 2026. By comparison, global trends over the same period are 9.5%, 10%, and 10.3%, respectively. For 2026, projected medical trend by market includes 16.9% in Singapore, 16.7% in Taiwan, 16.1% in the Philippines, 15.7% in Malaysia, 15.1% in Indonesia, and 14.9% in New Zealand. Thailand’s projected rate is 10.8%, below the Asia-Pacific average but above Hong Kong (9.9%) and Australia (8.3%). Across the region, 57% of insurers expect elevated medical trends to continue over the next three years.
Insurers in Asia-Pacific identify new medical technologies (77%), pharmaceutical advances (63%), limited cost sharing (51%), and fraud, waste, and abuse (51%) as key drivers of rising costs. Supply chain disruptions and trade policies are cited by 28% of respondents as additional contributors. A majority expect tariffs and trade policies to increase healthcare costs, with 69% forecasting an increase and 15% a significant increase.
Cost sharing features such as deductibles, coinsurance, and copayments are less prevalent in Asia-Pacific than globally, even though many insurers view them as cost-management tools. Deductibles are used in 39% of plans worldwide compared with 16% in Asia-Pacific; member copays appear in 27% of plans globally but 6% in the region. Premium cost sharing by insured members for group policies stands at 23% globally and 6% in Asia-Pacific.
