The co-payment scheme, which takes effect on March 1, is critical to reducing overconsumption of medical services and will keep healthcare costs and insurance premiums affordable in the long term, say analysts.
Co-pay is a health insurance cost-sharing arrangement where the policyholder pays a fixed percentage of medical expenses, such as 30%, with the insurer covering the rest.
Kasem Prunratanamala, head of research at CGS International Securities (Thailand), said the 30-50% co-pay scheme for all insured persons with excessive claims will be implemented from the beginning of March.
Specifically, co-pay applies to people with three or more claims per year for outpatient services for simple diseases where aggregate claims exceed 200% of their annual insurance premiums, said Mr Kasem.
The scheme also applies to those with aggregate claims for inpatient services of more than 400% of their annual premiums, excluding claims for serious illness or major surgery, he said.
However, this will only affect new health insurance policies purchased or renewed after March 2025, according to the Office of the Insurance Commission.
For each case, co-pay is not to exceed 50% of the medical bill. In cases where co-pay was a condition for policy renewal and the policyholder's claim does not meet the criteria for co-pay, the insurance provider will treat the claim using the same conditions as when co-pay is not required, said Mr Kasem.
"We believe a co-payment policy is necessary to reduce the moral hazard of overconsumption and overserving of medical services," he said.
"The scheme will encourage policyholders and their doctors to consider the necessity of the medical treatment and its cost so they can make an informed decision on appropriate healthcare services."
Co-pay helps cut insurance premiums by eliminating unnecessary claims and promoting financial stability in the insurance industry, according to CGS.
Insurers can provide a greater range of policies to match clients' various financial and healthcare needs, making healthcare coverage more affordable for individuals and families, said Mr Kasem.
"We believe co-pay encourages prudence and keeps healthcare costs and insurance premiums affordable and sustainable over the long term," he said.
CGS predicts co-pay will have a small impact on hospital chains listed on the Stock Exchange of Thailand, reducing their net profits by only 1-2% this year and revenue by 2-3%, said Mr Kasem.
Nontapat Sahakitpinyo, an analyst with Maybank Securities (Thailand), said medical expenses have risen significantly, posing a challenge to the country's ageing society.
"The co-pay approach is expected to lower premiums, making insurance more accessible in the long run, particularly for those who truly need it, such as the elderly and individuals with a history of serious illness," he said.