One set of doctors

I wrote article 36 with something close to admiration, and I stand by all of it. Thailand’s universal health coverage reaches 47.5 million people at around ฿4,298 each per year. It eliminated the correlation between poverty and infant mortality inside a decade. It is studied internationally as the model for how a middle-income country does this.

This article is about what it costs, and the cost isn’t money.

Only 72% of Thailand’s required national doctor quota is currently filled.

In Health Regions 2, 4 and 8 the figures are 61%, 63% and 66%. Ten provinces are below 60%.

The resignations

The public system is losing doctors, and the trend is not ambiguous.

Resignations from the public sector rose from 789 in 2020 to 1,201 in 2024.

And within that, the number that stopped me: nearly 900 newly qualified doctors quit within six months of entering government service.

Six months. After the better part of a decade of training. That is not people discovering they dislike medicine — it’s people discovering what the job is.

A workload survey found 65 hospitals where staff were working more than 40 hours a week, and nine where the workload exceeded 64 hours. Those are the recorded figures and anyone who has spoken to a Thai junior doctor will tell you the recorded figures are conservative.

What they’re leaving for

Meanwhile, on the other side of the same profession.

Thailand’s medical tourism sector was valued at around $8.6 billion in 2025, with 2026 projections near $9.5 billion. Roughly three million international patients in 2024. The Tourism Authority has talked about a ฿125 billion target for 2026, aimed particularly at high-net-worth visitors. Private hospitals take about 70% of total healthcare revenue.

I should say plainly that these market figures conflict with one another — one source puts 2026 at $6.8 billion where another puts it at $9.5 billion, and the definitions of what counts as a medical tourist vary wildly. The level is uncertain. The direction and the order of magnitude are not.

And here is the detail that reframes the whole thing:

Cosmetic surgery is around 25% of that market.

The sentence I don’t enjoy writing

Thailand trains a doctor. The public system needs that doctor in a provincial hospital operating at 61% of establishment. The private system offers predictable hours, manageable risk and considerably better pay — increasingly in aesthetic and wellness medicine serving foreign visitors.

The doctor goes private. Obviously the doctor goes private.

I want to be completely clear about this, because it is the paragraph most likely to be misread: this is not a criticism of any doctor. A person who has trained for a decade, is working sixty-four hours a week, and takes a job with reasonable hours and better pay has made the choice that any sane person makes. I would make it. You would make it. The people who stay in the public system past their obligation are doing something admirable, and nobody is obliged to be admirable for thirty years.

The problem is not the individual decisions. It’s that nobody is accountable for the sum of them.

Where I had article 61 wrong

Article 61 argued that Thailand outsources public functions to private companies — bill payment to 7-Eleven, food distribution to two wholesale markets, civic space to malls — and that this happens in the gaps where the state didn’t build. I cited universal healthcare as a counter-example: proof that where the Thai state does build, it builds superbly.

That’s still true and it’s incomplete.

Because this isn’t a gap being filled. The state built the thing, and the private sector is drawing down its critical input. Different pattern, opposite direction, and considerably harder to fix — you can’t tell a company to stop competing for staff, and you shouldn’t want to.

A public system can survive being underfunded. It cannot survive being out-recruited, because the funding gap shows up in a budget where someone can argue about it, and the staffing gap shows up as a doctor in Region 8 covering three people’s shifts until they resign.

The correction I’d make to article 61: private provision doesn’t only fill gaps. Sometimes it creates them, in the places where the state got it right.

And it’s the primacy problem again

Look at where the shortages are. Not Bangkok. Health Regions at 61% and provinces below 60%.

The private hospital cluster is in Bangkok. The medical tourists arrive in Bangkok. The specialist career, the training, the money and the professional community are all in Bangkok.

Article 65’s argument, wearing a white coat. The average Thai farmer is 58 because the young went to Bangkok. Provincial hospitals are at 61% for exactly the same reason, and the fix is exactly as difficult.

The Ministry has revised allocation plans and there are bonding requirements that hold new doctors in public service for a period. Those manage the flow. They don’t change the gradient, and a system that retains people by obligation rather than by being worth staying in is a system with a countdown on it.

What this means if you’re choosing a hospital

Practically, since some readers arrived here for that.

Thai private hospitals are genuinely excellent. The international ones are as good as anything in the region and better than a great deal in Europe, with far shorter waits. That reputation is earned.

The public system is also genuinely good and enormously cheaper, and its outcomes across the whole population are its actual achievement.

The difference you’re buying is largely time, comfort and language — not, in most cases, clinical quality. Article 02’s insurance piece is the companion to this.

And your private hospital doctor was very likely trained by the public system. That’s not a complaint. It’s just worth knowing what you’re standing inside.

Common misconceptions

“Thailand has world-class healthcare.” Both statements are true at once: the universal system is a genuine international model, and only 72% of the public doctor quota is filled.

“Doctors are leaving because they’re greedy.” They’re leaving sixty-four-hour weeks for predictable hours. It’s the rational choice and framing it as greed is how the actual problem gets ignored.

“Medical tourism brings money into healthcare.” It brings money into private healthcare. Whether any of it reaches the public system is a separate question and the answer isn’t obvious.

“The shortage is a funding problem.” Funding is part of it. A staffing gap is harder than a funding gap, because you cannot appropriate doctors in a budget.

“It’s a Bangkok problem.” Bangkok is where the doctors are. It’s a provincial problem caused by Bangkok.