Government employee healthcare budget soars to 90 billion baht; the Central Accounting Department plans to overhaul the system, with details to be finalized within one month.
The Director-General of the Comptroller General's Department revealed that the budget for civil servant medical expenses has soared to 90 billion baht annually, prompting plans to overhaul the system. Public consultations will be held on four issues: mandatory direct reimbursement, offering alternative insurance options, penalties for corruption, and increasing hospital transparency. A conclusion is expected within one month.
13 July 2569 – Mrs. Patricia Mongkhonvanit, Director-General of the Comptroller General's Department It was revealed that the government is currently considering public sector personnel costs and guidelines for improving civil servant welfare. Feedback from younger civil servants under 30 years old at the Comptroller General's Department revealed that this group does not desire pensions but rather higher salaries to maintain a decent standard of living.
"Young people these days say they want a salary that allows them to live comfortably at their current level, and it must be acknowledged that the salaries currently received are indeed difficult to live on in some areas. They also feel that because they already have a government pension fund (GPF), they want to save more themselves or use the money to plan their lives and invest in things they are interested in. They are also willing to purchase their own health insurance, but they want clarity from the government about what welfare benefits they will receive so they can plan accordingly."
However, any revisions to the rules regarding welfare expenses will only affect newly hired civil servants. Existing civil servants who have already signed employment contracts will not experience any reduction in their pensions.
Ms. Patricia further revealed that, regarding healthcare benefits, the Comptroller General's Department currently covers eligible individuals and their family members, including civil servants themselves, their parents, and children, totaling approximately 5 million people. More than half of this number are over 60 years old. However, with advancements in medical technology leading to longer life expectancy, coupled with increasingly complex diseases such as cancer (where current cancer treatments are expensive), and a significant increase in non-communicable diseases (NCDs) – partly due to lifestyle choices like sugary drinks and high-calorie foods – healthcare costs have risen.
"Medical expenses for civil servants have increased due to more complex illnesses. Treatment costs are highest during the last month or so of life, and the government covers civil servants until their final moments, resulting in a very high budget allocation. The Comptroller General's Department is allocated approximately 90 billion baht annually for this purpose, and the expenses are almost equal to that budget."
Currently, the Comptroller General's Department is soliciting public comments on amendments to the Royal Decree on Medical Welfare Benefits, focusing on four key issues for short-term solutions:
- Only direct payment systems are permitted. Medical benefits must be claimed through the direct payment system of the Department of Treasury to ensure accuracy and verifiability.
- The new criteria allow for the choice of alternative benefits. Previously, the law mandated that direct relatives of civil servants could only use civil servant benefits. However, it will give family members the option to use civil servant benefits, social security benefits, or the 30-baht universal healthcare scheme, as they wish.
- Measures to punish corruption include: if even one family member is found to have defrauded the healthcare system, such as using the benefits to buy medicine for resale, the entire family's healthcare benefits, including the civil servant who holds the benefits, will be revoked.
- Enhance transparency in healthcare facilities by establishing criteria that require hospitals to be transparent in prescribing medications and managing them according to good governance principles.
“Over the past 10 years, the Comptroller General's Department has detected accumulated damages from fraud amounting to approximately 200-250 million baht. Currently, the system handles over 35 million disbursement transactions annually, but there are only 6 officers directly responsible for auditing. This limits manual auditing. Therefore, we are currently developing a data analytics system to use technology to detect abnormal disbursement behavior, enabling faster and more accurate detection of fraud.”
Ms. Patricia revealed that another issue that may need to be prioritized as a national agenda is promoting the use of domestically produced generic drugs first, before using imported drugs which are many times more expensive.
"Generic drugs contain the same active ingredients as foreign drugs. We're not prohibiting the use of foreign drugs, but we might issue guidelines for doctors to start prescribing generic drugs first, and only if that's ineffective should they progress to more advanced medications."
Furthermore, it is crucial to combine efforts with behavioral modification to prevent disease, especially non-communicable diseases (NCDs), which are a major cause of rising healthcare costs. Public health agencies have previously proposed limiting snacks served in government agencies to no more than 100 calories per meal in order to promote health and reduce illness in the long term.
Regarding the concept of using an insurance system as an alternative. Ms. Patricia revealed that the Comptroller General's Department had previously studied this issue and found it to be difficult due to the complexity of the bureaucratic system, which differs from insurance companies in that insurance companies cannot provide coverage until the end of a patient's life. Furthermore, the administrative costs and expenses for clearing debts between insurance systems and hospitals are very high.
The public consultation process for this legislation will take approximately one month (between July 10 and August 8, 2026) before the information is compiled and submitted to the Cabinet for consideration and enforcement.
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