If most didn’t pay, insurance agencies would die here. Nobody would get it. I think the majority do well and a few outliers and subsequent bad reviews taint the whole market.
Look around. Almost every thai person is looking at their phones. Even the kids have phones. Everything here is done with phones and apps whether thai or foreigner.
It could. Small surgeries and outpatient services are normally affordable to pay out of pocket, but a catastrophic event like a motorbike accident or a heart attack or stroke that could leave you in the hospital for months could easily bankrupt you. I’d never go without some kind of catastrophic insurance.