REALIZING THE UTOPIAN VISION OF UNIVERSAL HEALTHCARE IN THAILAND
A conversation with Dr Jadej Thammatacharee about the 30-Baht promise
A conversation about public health in Thailand with Dr Jadej Thammatacharee, Secretary-General of Thailand’s National Health Security Office (NHSO)
(published in Bangkok Post, June 19, 2025)
by Philip J Cunningham
I recently met with Dr. Jadej, the secretary-general of NHSO, at the home of a mutual friend to ask questions, of which I had many, about the so-called 30-Baht scheme.
The doctor was generous with his time, clear and logical in his presentation. I came away with a better appreciation of what the program means for Thailand and what it hopes to be, where it came from and where it is going.
NHSO, the organization responsible for extending affordable, if not free, health care everywhere in Thailand, was established under the National Health Security Act of 2002. It is now one of the best-funded government bureaucracies, responsible for subsidizing national health care in keeping the populist premise that people of limited means should pay no more than 30 Baht per doctor visit.
Jadej credits simple but somewhat revolutionary idea behind the program to public-health civil servants such as Dr. Sanguan Nitayarumphong, who had been looking to implement variations on universal health care since the 1980s. Dr Prawet Wasi, the constitutional reformist popularly known as “Mo Prawet” was also an early booster.
The seemingly arbitrary political tag “30 Baht” has had unusual staying power, and it still represents the nominal fee per visit for health care. The tag, popularized by political consultant Pansak Vinyrat, was formally launched during Thaksin Shinawatra’s term as prime minister.
It is perhaps one of the most profound and lasting gains of a period that is chiefly remembered for its political divisiveness.
The modest fee, which critics scoffed at because 30 Baht sounded implausible, unworkable and deceptive, like a political slogan or rhetorical sleight of hand, still applies, and in some cases not collected at all.
There’s no doubt that opening up the floodgates to affordable care has put enormous pressure on state hospitals and increased the workload of healthcare professionals, but Jadej says these issues are being addressed through a combination of increased funding and finding creative and innovative ways of sharing the workload.
The program is expensive, comprising roughly 4% of the national budget, but is still less than the percentage of state expenditure in other countries where the coverage remains ad hoc and far from universal. And inasmuch as the program is credited for raising life expectancy in Thailand to one of the highest levels in the entire world, there’s something to be said for money well-spent.
All state hospitals are in the program, and private hospitals, which have more downtime and less crowded facilities are encouraged to take part as well in addition to their normal load of paying patients. It’s to the benefit of private hospitals to embrace the extra workload, with reimbursements, during downtime, and good for the purposes of training and specialization of private sector doctors.
The program is supported by a national network of pharmacies, about 5000, which are offered training and certification. The idea is to save on hospital visits by allowing the prescription drugs to be distributed by knowledgeable personnel in pharmacies across the country.
Administrators of the program have tried to reduce costs, pressures and workloads by emphasizing local care for less serious ailments, including the popularization of nurse care, and tambol-level care for fevers and routine ailments.
National Health Care in Britain is a model, but the Thai system is not as bogged down by red tape as in the UK, where, for example, a 15 minute per patient mandate means a doctor can only see four people per hour, resulting in long waiting times and wait lists.
Jadej acknowledges that Japan, known for its high life expectancy, has a fairly comprehensive program, but it is not a direct model for the Thai program and is not run centrally as is the case in Thailand.
As for China, it has excellent health care in cities but lacks doctors in proportion to its population, especially in rural areas. In earlier days this discrepancy led to the call for barefoot doctors, but such socialist schemes are not in favor now. Hospitals are increasingly well-equipped and doctors, accustomed to seeing hundreds or patients a week, are experienced, but the unreasonably long waits and delays opens the opportunity for bribes and line-jumping schemes for those with the money to pay.
Rwanda, the Thai administrator pointed out with a contrarian’s delight, has a superb health care model, at once innovative and fairly comprehensive program, all the more remarkable for a poor African country that not too long ago emerged from genocide
It was surprising to hear Jadej point to Cuba as a model, but he’s been there and seen how it works up close. Fidel Castro tended to rule by fiat, so once he gave word to produce doctors, the country's medical colleges churned them out to the point of having a surplus, or at least sufficient medical expertise that Cuba has for many years exported doctors to poor nations in Africa and Latin America.
Jadej likewise credited the controversial and now defunct Communist Party of Thailand which waged guerrilla war on the military establishment from remote bases in the mountains during much of the 1960s and 1970s for good healthcare. The CPT was small, and ultimately ineffective as it limped from one remote rural base to another, and got caught the crossfire of the Sino-Soviet split, but the rebels had many doctors in their jungle camps, many of them trained at Mahidol University, and the level of health care was good considering the circumstances.
Thai people now enjoy one of the best health programs in the world, Jadej asserts with pride. Another plus for Thai public health, he says, is the native Thai social structure by which the elderly are not shunted away to old age homes but live with their extended families and continue to interact with the community.
The NHSO secretary-general acknowledges that some right-leaning politicians tried to cut back the program after 2014, which he compares to similar efforts by Republicans in the US, but the attempts to rollback the program were effectively halted because of its popularity, its many stakeholders and widespread political support across the political divide.
People who are beneficiaries of the program are the best supporters of universal health care and they can be heard speaking up all over the country. There are people who are alive today because of comprehensive medical intervention that was beyond their financial means.
Studying medicine is popular and Thailand continues to produce many doctors, often best and brightest among their school cohorts. The doctor went on to say he didn’t like the Bamrungrad Hospital model of medical tourism but would rather see the best hospitals included in an equitable national system by which reasonably priced care is made available to Thais, foreign tourists and foreign residents.
He cites the example of a fast-growing hospital in Ubon that not only serves the province and all of south Isan, but is also a key medical hub for southern Laos and Cambodia as well.
Contrary to the nay-saying at its inception two decades ago, the program functions well and has extensive reach across the nation.
Thailand’s journey to something akin to universal health care in the matter of two decades is nothing short of remarkable, but it is still not fully appreciated in Thailand, let alone abroad. Jadej notes that UN agencies and the World Bank have taken an interest in it, and he ardently hopes the achievements and underlying philosophy behind universal care will be better understood in the future.