The Medical Service Reimbursement Operation for High-Cost Cases under the Migrant Health Insurance Scheme, Ministry of Public Health

Authors

  • Thamonphan Jinpong M.Sc. (Public Health Administration), Faculty of Public Health, Mahidol University
  • Prof Dr.Chardsumon Prutipinyo Department of Public Health Administration, Faculty of Public Health, Mahidol University
  • Assit Dr.Natnaree Aimyong Department of Epidemiology, Faculty of Public Health, Mahidol University

Keywords:

Medical Service Reimbursement, High-Cost Cases, Migrant Health , Insurance Scheme

Abstract

This mixed-methods study aimed to examine the operations and factors influencing Medical Service Reimbursement for High-Cost Cases of the Migrant Health Insurance Scheme, Ministry of Public Health. Quantitative data were derived from secondary data sets from the Ministry of Public Health, for fiscal years 2019–2023 (B.E. 2562–2566) and analyzed using descriptive statistics and multiple regression analysis. Qualitative data were collected through in-depth interviews with six key informants, including administrators and other relevant stakeholders, using semi-structured questionnaire.

           Findings revealed that the number of health insurance cardholders peaked in 2020 (712,177 individuals) and declined to 538,377 in 2023, with community hospitals maintaining the highest proportion of cardholders. Factors significantly influencing reimbursement payments included the number of service users (the primary factor), outpatient treatment (which decreased costs), and being a central hospital, general migrant group, or dependents under 7 years old (which increased costs). The model explained 30.6% of the variance in expenditures (R2=0.306).

           The fund continues to face financial sustainability challenges because insurance premiums do not reflect actual costs. Policy recommendations include adjusting the Adjusted Relative Weight (AdjRW) threshold from ≥ 4.00 to ≥ 2.00 to ensure hospitals receive appropriate compensation and to reduce unnecessary patient referrals. Additionally, the study suggests developing real-time data-reporting systems and advocating for legislative support to ensure comprehensive migrant coverage within the health system.

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Published

2026-09-01

How to Cite

Jinpong, T., Prutipinyo, P. D., & Aimyong, A. D. (2026). The Medical Service Reimbursement Operation for High-Cost Cases under the Migrant Health Insurance Scheme, Ministry of Public Health. Journal of Health Policy, Law and Administration, 12(3), 83–97. retrieved from https://so05.tci-thaijo.org/index.php/journal_law/article/view/289109

Issue

Vol. 12 No. 3 (2026): September-December

Section

Original Article

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