National Health Security Office confesses to hospital debt
National Health Security Office (NHSO) confirms it owes debt to every hospital nationwide. Officials acknowledge the debt is real and are preparing to fully explain the underlying causes.
- The National Health Security Office (NHSO) has confirmed it owes money to nearly every hospital, a statement supported by Prime Minister Anutin Charnvirakul.
- The debt is partly due to a "payment-by-performance" system where hospitals are reimbursed after services are provided, creating a natural lag in payments.
- The NHSO's fixed, "closed-end" budget was insufficient to cover higher-than-expected service usage, contributing to the shortfall.
- A proposal has been made to request approximately 8 billion baht from the central government budget to cover the deficit and clear the outstanding hospital accounts.
Prime Minister Anutin Charnvirakul recently addressed the financial situation of the National Health Security Office (NHSO), stating that the agency must urgently manage its finances as it owes money to virtually every hospital.
He mentioned that a proposal is underway to request a central budget allocation to clear these accounts, with the matter currently under consideration by the Bureau of the Budget.
Dr Atthaporn Limpanyalert, Deputy Secretary-General of the NHSO, confirmed the Prime Minister's statement, acknowledging that the NHSO indeed owes money to all hospitals on October 9, 2025.
Atthaporn explained that when the NHSO receives its annual budget from the government, funds are allocated through various methods:
- Advance Payments: A fixed capitation rate is paid to hospitals in advance to cover outpatient services and health promotion/disease prevention.
- Payment-by-Performance: Payments for services, like inpatient care, are made after the hospitals provide the service, usually every month.
This mechanism naturally means that the NHSO is always technically in debt to the hospitals at any given time.
The NHSO budget is calculated on a per-capita basis, like an insurance premium, determined by factors such as the service utilisation rate from the previous year, new services introduced, and inflation.
Dr Atthaporn stated, "This year, the budget is approximately 4,100 baht per person per year. The NHSO operates under a closed-end budget (a fixed amount that must cover all expenses)."
"When the budgeted amount is genuinely insufficient for example, due to a new policy or higher-than-expected service usage the NHSO is forced to request additional funds from the central budget reserve. The NHSO has currently requested approximately 8 billion baht from this central budget."
When asked if the requested central budget funds would be used directly to clear hospital debt, Dr Atthaporn clarified that the funds would cover several areas, but the majority would be used to reconcile expenses that exceeded initial projections.
He affirmed that once the central budget is secured, these outstanding accounts would be cleared immediately, as the figures are already documented.
