Thailand is considering new regulations that would require international visitors to obtain accident insurance prior to entry, as rising unpaid medical bills and accident-related cases place increasing pressure on the country’s public healthcare system.
At Vachira Phuket Hospital, the financial strain is already evident. Dr Weerasak Lorthongkham, the hospital’s director, said the facility — which serves around 400,000 registered residents and more than one million visitors — absorbs substantial unpaid treatment costs each year.
“Each year, we absorb about 10 million baht in treatment costs for foreign patients without insurance,” he said.
He noted recurring risk patterns among tourists, particularly involving first-time motorcycle use and substance consumption. “Many visitors come to Phuket and try riding motorcycles for the first time, which increases accident risks.”
Dr Weerasak cited a severe case involving a Russian tourist who sustained a spinal injury and required extended care.
“The patient could only move his head. The treatment cost more than 1 million baht, and there was no payment. The family could not be reached, and the embassy could only assist administratively,” he said.
He added that the hospital ultimately arranged and financed the patient’s return home. “This is not a single case. It happens across nationalities.”
Such incidents reflect a broader nationwide issue.
The Ministry of Public Health estimates that unpaid medical bills from foreign patients reach at least 100 million baht annually, with key tourism destinations such as Phuket and Chiang Mai among the hardest hit.
Dr Somruk Jungsaman, the ministry’s permanent secretary, said officials are currently compiling detailed data to better assess the scale of the problem.
“We need clear data to assess the scale of the problem and design appropriate measures,” he said. “Both the level of insurance and payment mechanisms will be discussed with relevant agencies.”
Hospitals are ethically obliged to provide emergency care regardless of a patient’s ability to pay, leaving medical facilities to shoulder the financial burden.
Accidents a Key Driver
Road accidents remain a leading cause of hospitalisation among tourists, particularly those unfamiliar with local driving conditions. Motorcycle use continues to be a major risk factor, especially during peak travel seasons.
Globally, emergency medical claims averaged around 60,000 baht in 2025, reflecting rising healthcare costs. However, many travellers to Thailand still arrive without sufficient insurance coverage.
Industry data indicates that travel insurance for a two-week trip costs roughly 1,100 baht and typically offers medical coverage ranging from 3.6 million to 9 million baht. Despite its affordability, uptake remains inconsistent.
For years, Thailand prioritised increasing visitor numbers over protective measures, allowing many tourists — particularly under visa-free schemes — to enter without insurance. That approach is now being reassessed as associated costs continue to rise.
Sisdivachr Cheewarattanaporn, chairman of the Association of Thai Travel Agents, said previous policies focused more on growth than risk mitigation.
“Mandatory fees and insurance were not prioritised before, as we focused on attracting tourists,” he said.
A proposed 300-baht entry fee for air arrivals remains under cabinet review, but policymakers are increasingly viewing compulsory insurance as a more targeted solution.
“Travel insurance is now affordable, but proper verification is needed to ensure travellers are covered,” he said.
Limited Avenues for Recovery
Attempts to recover unpaid medical bills through diplomatic channels have seen limited success.
Dr Supakit Sirilak of the Health Systems Research Institute said embassies generally regard medical expenses as a personal responsibility.
“I support limiting the ministry’s burden. If insurance cannot be enforced, tourism agencies should help subsidise the losses,” he said.
Hospitals are unable to detain patients over unpaid bills, as doing so could harm Thailand’s international reputation.
Mandatory travel insurance is already required in several regions, including the Schengen Area, the United Arab Emirates, Russia and Cuba. In many cases, insurance is integrated into visa processes or bundled with travel costs to ensure compliance before arrival.
Industry observers suggest Thailand could adopt a similar approach by linking insurance requirements to entry procedures or airline ticket purchases, helping to safeguard public finances while improving traveller safety — particularly for those engaging in higher-risk activities.
Amid shifting global conditions, including rising fuel costs and more cautious consumer spending, the tourism sector is increasingly reassessing its priorities. A transition from volume-driven growth to a value-based model is gaining traction.
“Implementing stricter entry regulations could benefit both the country and its visitors,” Mr Sisdivachr said. “It would ensure safer travel and reduce pressure on public healthcare.”
At the policy level, momentum appears to be building.
Public Health Minister Pattana Promphat said the government is prepared to move forward with the proposal. “We are ready to push this forward and already have plans in place.”
He emphasised that determining appropriate levels of insurance coverage remains a key consideration. “The issue is how much coverage is appropriate and the total burden from foreign patients across the country.”
The minister added that any framework must also account for different groups, including tourists and migrant populations, particularly in border areas.
“Strengthening this mechanism will help reduce the burden and improve the overall system,” he said.
