Institutionalizing Public Consultation in Thai Health Legislation: Lessons from RIA and PLS Practices

Public consultation is increasingly recognized as a cornerstone of democratic governance, yet its institutionalization in middle-income democracies such as Thailand remains uneven. Although the 2017 Constitution and the 2019 Act on Legislative Drafting and Legal Evaluation mandate participatory processes through Regulatory Impact Assessment (RIA) and Post-Legislative Scrutiny (PLS), implementation has often remained procedural rather than substantive. This study examines how consultation practices operate within Thailand’s public health legislation, a policy domain characterized by significant distributive and ethical implications. Using a qualitative comparative case study design, the research analyzes three legislative processes: the National Health Security Act B.E. 2545 (2002), the Draft Act on Organ and Tissue Donation and Transplantation, and the Emergency Medical Services Act B.E. 2551 (2008). Documentary evidence was analyzed using four analytical dimensions: process design, stakeholder inclusion, feedback and responsiveness, and contextual fit. The findings reveal substantial variation across cases. The National Health Security Act demonstrates relatively inclusive and iterative consultation supported by transparent feedback mechanisms, whereas the organ donation draft law relies primarily on expert-centered consultation with limited public engagement. The Emergency Medical Services Act incorporates operational stakeholders but provides few opportunities for citizen participation or systematic feedback. These patterns suggest that consultation in Thailand often functions as a procedural requirement rather than a deliberative governance mechanism. Strengthening consultation across the regulatory lifecycle, broadening stakeholder inclusion, and institutionalizing transparent feedback mechanisms are, therefore, critical to enhancing the democratic legitimacy and policy effectiveness of health legislation.