Abstract
Objectives
Occupational health services (OHS) are essential components of public health systems, aiming to prevent work-related diseases, promote safe working environments, and protect workers’ health. Although OHS have been implemented in Thailand, the incidence of occupational health–related fatalities remains high. This study aimed to assess the current status of occupational health service provision for both domestic and migrant workers in Thailand, including the relevant regulatory frameworks and policy arrangements.
Methods
A narrative policy and systems review was conducted in 2025 to examine the provision of occupational health services in Thailand, the national healthcare system, and relevant laws, policies, and regulations.
Results
The study revealed that Thailand has legislation mandating health examinations for domestically employed workers exposed to occupational risk factors, regulated by the Ministry of Labour, alongside standards for healthcare facilities delivering occupational health services established by the Ministry of Public Health. However, significant gaps remain, particularly in data integration and, importantly, the absence of a comprehensive occupational health care framework for Thai workers employed overseas.
Conclusion
Strengthening policy coherence between the Ministry of Labour and the Ministry of Public Health, together with the establishment of a national occupational safety and health institute, is recommended to support the sustainable development of occupational health services. In addition, international initiatives such as health checkup programs for Thai overseas workers provide a valuable platform for cross-border occupational health surveillance and continuity of care.
Keywords: health policy and regulation, labour protection, occupational health services, Occupational Health Services (OHS) system
Introduction
Occupational health services are preventive programs designed to maintain and promote a healthy working environment. Their primary aim is to protect and enhance workers’ physical and mental well-being, while ensuring that job demands are adapted to workers’ capabilities and health status1). Thailand has ratified two key International Labour Organization (ILO) conventions related to occupational safety and health: the Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187), ratified on 23 March 2016 and entered into force on 23 March 2017; and the Occupational Safety and Health Convention, 1981 (No. 155), ratified on 10 June 2025 and scheduled to enter into force on 10 June 20262). These ratifications have contributed to the development of clearer national occupational safety and health policies and strategic plans that are increasingly aligned with international standards and practices3). According to 2022 data from the Workmen’s Compensation Fund Office of Thailand, the incidence of fatal occupational injuries among workers in Thailand was 5.3 cases per 100,000, substantially higher than reported rates in Japan (1.3 cases per 100,000) and England (0.8 cases per 100,000)4). This indicates that occupational injuries remain a substantial public health burden in Thailand.
Despite the critical role of Occupational Health Services (OHS) in safeguarding workers’ health and ensuring labour protection, information on the current status of occupational health service provision in Thailand remains limited. The delivery of OHS, both in Thailand and internationally, is characterized by complex systems involving multiple stakeholders responsible for service provision, quality assurance, resource allocation, and regulatory oversight. These systems are further shaped by diverse legal and policy frameworks. Consequently, a comprehensive analysis of service organization, quality, resources, and governance mechanisms is essential to identify gaps and inform strategies for strengthening high-quality occupational health service delivery.
Therefore, this study aims to assess the current situation of occupational health services for both domestic and migrant workers in Thailand, with a particular emphasis on organizational and management structures, legal and regulatory frameworks, policy development, and their translation into practical implementation.
Methods
This narrative review was conducted between 2024 and 2025 as a health systems analysis to examine the structure, regulatory frameworks, and service delivery of occupational health services in Thailand. The review focused on national policies, institutional arrangements, and healthcare system mechanisms relevant to occupational safety and health. Secondary data were collected from official government sources, including legislation, policy documents, national statistics, and technical reports issued by the Ministry of Labour (MOL), the Ministry of Public Health (MOPH), particularly the Department of Disease Control (DDC), and related agencies.
Data were synthesized thematically and interpreted using the Overseas Health Checkup Initiative (OHCI) to identify policy-relevant gaps and opportunities for strengthening continuity of care for workers5).
Results
1. Workforce and Employment Context of Thailand
As of December 31, 2023, Thailand’s total population was 66,052,615 people6). Approximately 59.3 million were aged 15 years and older, of whom about 40.7 million were of working age. Among this group, 40.3 million were employed, including approximately 21 million informal workers and about 19 million formal workers7). Additionally, about 318,000 individuals were unemployed, while 114,000 were categorized as seasonal workers. Sectoral employment patterns reveal that the three largest industries by number of employed individuals were agriculture, forestry, and fisheries (12.1 million), wholesale and retail trade, including repair of motor vehicles and motorcycles (6.65 million), and manufacturing industries (6.62 million). The agricultural sector accounts for a considerable share of the workforce, with employment fluctuating between 11.1 and 12.8 million due to seasonal variations8). As of November 2024, Thailand hosted 3,350,969 foreign workers. Of these, 3,066,840 (91.52%) originated primarily from Myanmar, Laos, Cambodia, and Vietnam. During the same period, 140,982 Thai workers were employed overseas, with the top three destination countries being Taiwan, the Republic of Korea, and Japan. The most in-demand occupations were classified as elementary occupations, including agricultural labourers, metal product manufacturing workers, and general industrial labourers9).
2. Occupational Injuries and Diseases
According to data from the MOL, the rate of employees receiving workmen’s compensation for work-related injuries or illnesses decreased from 7.67 per 1,000 employees in 2020 (85,533 cases) to 7.23 per 1,000 employees in 2024 (87,728 cases). Among all reported cases, those resulting in work absences exceeding 3 days accounted for an average of 29.42%. Cases involving partial loss of limbs, fatalities, and permanent disability accounted for 1.10%, 0.73%, and 0.02% per year, respectively.
In 2024, the five most frequently reported occupational diseases were musculoskeletal disorders (1.55 cases per 1,000 compensated employees; 136 cases), biological diseases (0.58 cases per 1,000 compensated employees; 51 cases), skin diseases (0.39 cases per 1,000 compensated employees; 34 cases), noise-induced hearing loss (0.35 cases per 1,000 compensated employees; 31 cases), and pneumoconiosis (0.11 cases per 1,000 compensated employees; 10 cases)10).
In contrast, data from the Health Data Center (HDC) of the MOPH, which collects nationwide health information from public healthcare facilities, indicate that among work-related diseases, the top five conditions were musculoskeletal disorders, pesticide poisoning, organic solvent poisoning, noise-induced hearing loss, and silicosis. The corresponding incidence rates were 134.06, 11.62, 1.24, 1.10, and 0.57 cases per 100,000 population, respectively11).
3. Legal and Institutional Framework for Occupational Safety and Health
3.1 MOL is the primary government agency responsible for labour policy, employment, and workforce protection in Thailand. It oversees workplace safety, working conditions, and labour protection across all industries through key agencies, including Department of Labour Protection and Welfare (DLPW), which enforces labour laws, ensures workplace safety, and regulates employee benefits, and the Social Security Office (SSO), which manages social insurance systems for formal workers within the country, including compensation for work-related injuries or illnesses, and unemployment benefits, according to the following legislation.
3.1.1 The Occupational Safety, Health, and Environment Act, B.E. 2554 (2011)12), supervised by the Department of Labour Protection and Welfare, mandates that employers establish, manage, and implement occupational safety and health and environmental measures in the workplace. Compliance with relevant ministerial regulations associated with this Act is required.
One key regulation is the Ministerial Regulation on Establishing Standards for Health Examinations of Employees Working with Occupational Hazards, B.E. 2563 (2020)13), which specifies requirements for health examinations. Employers are required to conduct health examinations for employees exposed to occupational hazards at three stages: an initial examination within 30 days of commencing employment, annual health examinations, and examinations upon job transfer involving different hazards. Health examinations must be carried out by occupational health physicians or doctors who have completed basic occupational health training. Employers are required to maintain health examination records for at least two years after termination of employment for general hazards, and for at least ten years for work involving carcinogens. If an abnormality related to work conditions is identified, employers must report the case to the Department of Labour Protection and Welfare within 30 days. Although pre-termination health examinations are not legally required, employers remain responsible for ensuring a safe working environment and monitoring workers’ health to mitigate risks.
3.1.2 The Workmen’s Compensation Act, B.E. 2537 (1994)14), supervised by the Social Security Office, provides compensation for formal workers covered under Section 33 of the Social Security Act who are diagnosed with occupational diseases or work-related illnesses or injuries. Eligible workers are entitled to benefits for medical treatment, rehabilitation, and income replacement through the Workmen’s Compensation Fund (WCF).
3.2 Ministry of Industry (MOI) plays a key role in ensuring safety related to buildings, premises, machinery, and equipment, and in regulating hazardous substances. The Hazardous Substances Act15), supervised by the Department of Industrial Works, regulates the importation, production, use, storage, transportation, and disposal of hazardous substances and related activities involving hazardous chemicals.
3.3 MOPH plays a significant role in providing medical services, health surveillance, and clinical care for workers. The Division of Occupational and Environmental Diseases (DOED) under the Department of Disease Control (DDC) is the primary agency responsible for developing policies on the prevention and control of occupational diseases, conducting disease surveillance and investigations. Meanwhile, the Department of Medical Services (DMS) serves as the national specialized center for occupational medicine services, and the Office of the Permanent Secretary (OPS) is responsible for integrating services across the public hospital network.
3.3.1 The Occupational and Environmental Diseases Control Act, B.E. 2562 (2019)16), administered by the DOED under the DDC, provides the legal framework for health surveillance and the management of occupational diseases of public health concern. The Act currently covers five priority occupational conditions: silicosis, asbestos-related diseases, lead poisoning, pesticide poisoning, and illnesses resulting from confined spaces. It mandates the reporting of health examination results, case investigations, and case management related to these diseases. Furthermore, the Act regulates healthcare service units providing occupational medicine, including health check-ups for workers in both the formal and informal sectors. These services must comply with established standards for health examinations, specimen collection, laboratory services, occupational health personnel, and medical devices. Healthcare service units providing such services are required to register with the DDC.
3.3.2 Other agencies: Several other agencies also contribute to the provision of occupational medicine services. Although not governed by a specific Act, their roles and responsibilities are defined by Ministerial Regulations regarding the organizational structure of their respective departments based on their specific missions.
• DMS: The Ministerial Regulation on the Organization of the Department of Medical Services B.E. 2562 (2019)17) assigns Nopparat Rajathanee Hospital the responsibility of developing specialized medical knowledge and technologies and providing tertiary referral services, particularly in the fields of occupational and environmental medicine.
• OPS: The OPS, which is tasked with driving health service delivery to achieve the Ministry’s objectives and overseeing public hospitals at the primary, secondary, and tertiary levels18) has integrated occupational medicine into the primary care mission, operating under the supervision of tertiary care hospitals.
The overall institutional relationships among these ministries and service providers are summarized in Figure 1.
Fig. 1.
Relevant ministries involved in occupational health services in Thailand
4. Structure of the Healthcare System in Thailand
The MOPH is the primary agency responsible for overseeing Thailand’s healthcare system. Public health care services are categorized into three tiers19,20,21,22), as follows.
4.1 Primary care includes 10,098 facilities such as Subdistrict Health Promoting Hospitals and Urban Community Health Centers, which provide essential services like disease prevention, health promotion, general practice, and basic diagnostics. Each primary care unit is required to have at least 1 registered nurse.
4.2 Secondary care comprises 769 hospitals, classified as small (F3, 10 beds), medium (F2, 30–90 beds), large (F1, 60–120 beds), and advanced community hospitals (M2, ≥120 beds). These hospitals provide both inpatient and outpatient services with progressively higher levels of clinical capacity and specialization.
4.3 Tertiary care includes 134 hospitals delivering specialized and highly specialized services, including small general hospitals (M1), large general hospitals (S), and regional center hospitals (A). Regional center hospitals also serve as teaching and research institutions and act as referral centers for lower-level hospitals within the same health area network. A detailed classification of hospital levels, types, and facilities is presented in Table 1.
Table 1. Classification of Hospitals under the Office of the Permanent Secretary19,20,21,22).
| Level | Type | Facilities |
|---|---|---|
| Primary Care | - Subdistrict Health Promoting Hospital - Urban Community Health Center |
- Provide basic healthcare services to the community, including disease prevention, health promotion, and primary care. Serve as the frontline of the public health system at the sub-district level. - Capability in essential medical services: General practice, dentistry, pharmacy, laboratory diagnostics, physical therapy or occupational therapy, and traditional or alternative medicine. - The objective is to provide outpatient care to reduce overcrowding in larger hospitals. Includes family medicine services and community health work. - Staff may work on a temporary rotation basis or as permanent staff. However, there must be at least one professional nurse. |
| Secondary care | Small Community Hospital (F3 level) | - A small community hospital with 10 beds. - staffed by general practitioners or family medicine doctors. - Does not require major surgical facilities and focuses on outpatient services. |
| Medium Community Hospital (F2 Level) | - A medium-sized community hospital with 30-90 beds. - staffed by general practitioners or family medicine doctors. - Provides standard services with no medical specialists. ER 24 hours, X-ray, Labor service. |
|
| Community Hospital (F1 Level) | - A large community hospital with 60-120 beds. - staffed by general practitioners or family medicine doctors. Includes specialists in major fields such as internal medicine, surgery, obstetrics and gynecology, and pediatrics. |
|
| Advanced Community Hospital with Referral Services (M2 Level) | - A community hospital with 120 or more beds. - staffed by general practitioners or family medicine doctors and specialists in at least six fields. Specialized fields include internal medicine, surgery, pediatrics, obstetrics and gynecology, orthopedics, and anesthesiology. |
|
| Tertiary care | Small General Hospital (M1 Level) | - A hospital capable of treating patients requiring complex care at the specialized level. - Staffed by specialists in major fields and selected sub-specialties. Serves as a referral hospital for medium-level. |
| Large General Hospital (S Level) | - A hospital capable of treating patients requiring complex care at the highly specialized level. - Staffed by specialists and sub-specialists in core fields. Serves as a referral hospital for Standard Level. |
|
| Center Hospital (A Level) | - A hospital capable of treating patients requiring advanced care at the highest level. - Equipped with advanced and sophisticated medical technology. - Focuses on research, teaching, and innovation in medical sciences. Staffed by specialists and sub-specialists across various fields. - Serves as a referral hospital for advanced level. |
4.4 The Private Sector plays a significant role in supporting public health services under the supervision of the MOPH. According to data from the National Statistical Office, Ministry of Digital Economy and Society (2022), Thailand has 399 private hospitals and medical facilities nationwide. Of these, 354 facilities (88.7%) are classified as general hospitals, while 45 facilities (11.3%) are specialized hospitals23)
Healthcare entitlements in Thailand are provided through three main schemes. The Universal Health Coverage Scheme (UCS) covers Thai citizens holding a national identification card and allows access to medical services at designated healthcare facilities. Civil servants are covered under the Civil Servant Medical Benefit Scheme (CSMBS), which provides direct reimbursement through the Comptroller General’s Department. Employees in the formal sector are covered by the Social Health Insurance (SHI) scheme administered by the Social Security Office.
5. Occupational Health Service
Occupational health services (OHS) in Thailand are delivered through multiple levels and organizations. At the enterprise level, labour legislation requires certain workplaces to establish infirmary or occupational health facilities to provide basic health services for employees. These services may include preliminary occupational health care, such as return-to-work assessments conducted by multidisciplinary teams. However, most enterprises rely on public or private healthcare facilities to provide comprehensive occupational health services.
Within the public sector, the MOPH mandates that public hospitals, operating under the provincial health office structure, establish occupational health service units as part of their organizational framework. These services are integrated into the primary care mission, which emphasizes health promotion, disease prevention, and disease control across all health conditions24). The occupational health service framework in tertiary-level hospitals is shown in Figure 2.
Fig. 2.
Positioning of occupational health services within the primary care mission of tertiary hospitals
6. Occupational Health Service Quality Control
Thailand has implemented several national initiatives to enhance the quality of OHS delivery through structured programs, quality assessment mechanisms, and regulatory frameworks.
6.1 The Occupational Disease Clinic Project is a collaborative initiative between the MOPH and the Social Security Office, supported by the Workmen’s Compensation Fund. The project aims to establish occupational disease clinics in public hospitals across all provinces in Thailand to improve access to services for formally employed workers with work-related illnesses. The primary objective of the project is to provide timely, convenient, and comprehensive services for the diagnosis, treatment, rehabilitation, and medical surveillance of occupational diseases. Participating hospitals receive financial support from the Workmen’s Compensation Fund to strengthen service delivery, including health surveillance for workers exposed to occupational risk factors, diagnostic and initial treatment services, capacity building of healthcare personnel, equipment calibration and service standard development. This project also promotes collaboration between public hospitals and agencies under the MOL. As of 2025, a total of 130 public hospitals nationwide have participated in the project, covering all provinces in Thailand. In 2024, participating hospitals diagnosed 3,031 cases of occupational or work-related diseases that were successfully submitted for compensation through the Workmen’s Compensation Fund. Nearly all tertiary public hospitals (M1, S, and A levels) have participated in this initiative.
6.2 Occupational and Environmental Medicine Quality Assessment. Additionally, Thailand has implemented a voluntary Occupational and Environmental Medicine Quality Assessment system25), managed by the DDC under the MOPH. This system complements general hospital accreditation and aims to promote high-quality occupational health services for workers in both formal and informal sectors. Hospitals meeting the required standards receive a quality recognition certificate. To date, 121 regional and general hospitals, 554 community hospitals, and 2,291 primary care units have met the established standards nationwide. More than 75% of tertiary public hospitals (M1, S, and A levels) have achieved a “good” or higher assessment level. Evaluation criteria cover leadership and management systems, occupational services for healthcare workers, proactive occupational health activities, occupational medicine services, and environmental health services. Good, very good, and excellent levels require at least 80% achievement in core occupational health domains, along with progressively higher environmental health scores.
6.3 Standard of services and Registration of Occupational Health Service Units under the Occupational and Environmental Diseases Control Act, B.E. 2562 (2019)26), standards for occupational health service provision and the registration of occupational health service units are formally mandated. Hospitals providing occupational health examinations to employees or informal workers, either onsite or through outreach services, are required to comply with prescribed service standards. These standards include health examinations based on occupational risk factors, pre-employment health examinations, fitness for work or return to work assessments, biological specimen collection, and laboratory services. Service units must also meet personnel standards, including the involvement of occupational medicine physicians or physicians who have completed basic occupational medicine training, as well as occupational health nurses or nurses who have completed occupational health training. In addition, facilities are required to possess essential occupational health equipment that meets recognized international standards, such as audiometers compliant with ANSI S3.6–1996 standards and spirometers compliant with ATS/ERS 2005 standards or equivalent. However, health system reports indicate that meeting these personnel standards remains a practical challenge for many facilities due to the limited number of specialized occupational health professionals nationwide.
Once these standards are met, hospitals are required to register as occupational health service units with the DDC. Failure to comply with the registration requirements may result in criminal penalties, including fines and/or imprisonment for non-compliant service units, as well as administrative fines imposed on enterprises that arrange employee health examinations through non-certified service providers. At present, implementation of the service unit registration system remains under development, including the establishment of an electronic registration platform to support regulatory oversight. Full enforcement of the registration process by the DDC is anticipated in the first quarter of 2026.
Discussion
Occupational health systems in Thailand have been developed in alignment with the frameworks of the World Health Organization (WHO) and the International Labour Organization (ILO), particularly the principles outlined in ILO Convention No. 161 and the WHO model of basic occupational health services. However, system implementation has evolved under a parallel governance structure, resulting in overlapping institutional responsibilities in certain aspects of worker health protection. Occupational disease reporting and surveillance are also administered through separate ministerial systems, with limited interoperability.
The enactment of the Occupational and Environmental Diseases Control Act (2019) represents a significant policy advancement by formalizing the registration process and quality assurance mechanism for OHS units. Enhanced collaboration between the MOPH and the MOL has strengthened regulatory enforcement and expanded surveillance mechanisms, including the extension of occupational health risk examinations to informal workers under the national health protection scheme.
Despite these advances, several challenges persist. Limited integration between the MOL’s Workmen’s Compensation Fund and the MOPH’s Health Data Center constrains data interoperability and impedes the development of comprehensive national estimates of the burden of occupational diseases. Additional challenges include shortages of trained occupational health professionals across healthcare facilities. Furthermore, Thai migrant workers employed overseas remain largely excluded from systematic occupational health screening and surveillance programs. Coupled with the absence of a systematic national framework for post-repatriation follow-ups and cross-border health data integration, these workers remain vulnerable to unmonitored long-term occupational exposures. Addressing these challenges through improved data interoperability, strategic workforce development, and strengthened cross-border health collaboration is essential for advancing Thailand’s occupational health system in the context of globalization and labour mobility. Beyond domestic system strengthening, international initiatives such as the Overseas Health Checkup Initiative (OHCI), commissioned by the Ministry of Health, Labour and Welfare of Japan, provide an important platform for cross-border occupational health surveillance and continuity of care5).
Conclusions
Thailand’s occupational health system demonstrates continuous progress in policy integration, quality assurance, and disease surveillance. The forthcoming ministerial enforcement of the Occupational and Environmental Diseases Control Act, B.E. 2562 (effective from the first quarter of 2026), marks a pivotal transition from policy development to full regulatory implementation. This enforcement is expected to strengthen service standardization, enhance the registration and oversight of occupational health service units, and improve the quality and coverage of occupational health services nationwide.
Looking ahead, sustained interministerial collaboration between the MOPH and the MOL, together with enhanced data interoperability across disease surveillance and compensation systems, will be essential for generating comprehensive and reliable national estimates of occupational disease burden. Strategic investment in workforce development, especially occupational medicine and allied health professions, will be critical to enhancing system capacity and resilience. In parallel, expanding occupational health coverage to informal workers and migrant populations, along with reinforcing cross-border occupational health initiatives, will be necessary to ensure equitable protection in the context of increasing globalization and labour mobility. Collectively, these measures represent key foundations for achieving comprehensive, high-quality occupational health protection for all workers in Thailand.
Funding
This work was financially supported by a Research of Industrial Disease Clinical Research Grants (230101-01), funded by the Ministry of Health, Labour and Welfare, Japan.
Conflict of Interest
The authors declare no conflicts of interest related to this study.
Acknowledgments
The authors gratefully acknowledge the Department of Environmental Medicine, Kochi Medical School, Kochi University, for their valuable collaboration, financial support, and academic guidance throughout the study. We also extend our sincere appreciation to the Raj Pracha Samasai Institute and its dedicated team for their essential role in the implementation and field coordination of this study. In addition, we thank the Department of Disease Control, Ministry of Public Health, Thailand, for institutional support and facilitation of this research.
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