The study aimed to compare the 2 main types of insurance used by colorectal cancer (CRC) patients in auniversity hospital in Thailand: universal coverage (UC) and ‘Civil Servant Medical Benefit Scheme’ (CSMBS)in terms of hospital expenditure and survival outcomes. CRC cases in stages I-IV who were operated on and hadcompleted their adjuvant therapy in Songklanagarind Hospital from 2004 through 2013 were retrospectivelyreviewed regarding their hospital expenditure, focusing on surgical and chemotherapy costs. Of 1,013 casesanalyzed, 524 (51.7%) were in the UC group while 489 (48.3%) belonged to the CSMBS group. Cases withstage IV disease were significantly more frequent in the UC group. Average total treatment expenditure (TTE)was 143,780 Thai Baht (THB) (1 US$ =~ 30 THB). The TTE increased with tumor stage and the chemotherapycost contributed the most to the TTE increment. TTE in the CSMBS group was significantly higher than in theUC group for stage II-III CRCs. The majority of cases in the UC group (65.5%) used deGramont or Mayo astheir first line regimen, and the proportion of cases who started with a capecitabine-based regimen (XELOX orXeloda®) was significantly higher in the CSMBS group (61.0% compared to 24.5% in the UC group, p-value <0.01). On survival analysis, overall survival (OS) and progress free survival in the CSMBS group were significantlybetter than in the UC group. The 5-year OS in the CSMBS and UC groups were 84.3% and 74.6%, respectively(p-value < 0.01). In conclusion, the study indicates that in Thailand, the type of insurance influences resourceutilization, especially the choice of chemotherapy, in CRC cases. This disparity in treatment, in turn, results ina gap in treatment outcomes.