Thailand’s health financing resilience during COVID-19: leveraging universal health coverage to tackle the pandemic

BACKGROUND: The COVID-19 pandemic constituted a public health emergency in Thailand from March 2020 to October 2022, testing the resilience of the health financing system. This study establishes an analytical framework to examine Thailand's public health financing arrangements and their subsequent impacts on public hospital financial reserves during this crisis. METHODS: This mixed-methods study developed an analytical framework to examine Thailand's public health financing response. The study analyzed COVID-19 public health expenditure data (Fiscal Years (FY) 2020-2022) and financial data from 866 Ministry of Public Health hospitals (FY 2015-2022) using descriptive statistics and trend analysis. These quantitative findings were integrated with a thematic analysis of 21 key informant interviews. RESULTS: Thailand enhanced health financing resilience through adaptive revenue mobilization and flexible resource allocation. Between FY 2020 and 2022, the government expanded fiscal space by mobilizing approximately US$13.78 billion via the Emergency Loan Decrees, Central Budget, and Social Security Fund. Universal Health Coverage (UHC) mechanisms expanded service coverage and expedited provider reimbursement. During delayed loan disbursements, public hospitals used internal financial reserves to bridge funding gaps and maintain service continuity. Consequently, net hospital reserves increased substantially by the pandemic's end compared to pre-pandemic baselines. CONCLUSIONS: Thailand strategically leveraged its UHC system and mobilized emergency and pre-existing public funds to secure fiscal space and maintain system resilience. However, temporary funding influxes may mask localized resource strains on hospital financial reserves. To enhance future resilience, Thailand should establish a dedicated health emergency reserve fund, streamline extra-budgetary mechanisms, and adopt flexible procurement regulations.