OBJECTIVES: Laparoscopic surgery (LS) requires advanced and expensive surgical instruments but offers better quality of life and shorten hospitalization compared to conventional surgery. This study aimed to evaluate the utilization of LS between patients under Civil Servant Medical Benefit scheme (CSMBS) and those under Universal Coverage scheme (UC) and to determine the factors associated with the provision of LS in most common diseases.  METHODS: A hospital data of patients undergoing LS were obtained from the Central Office for Healthcare Information. The database contained 686,553 admissions with principle diagnoses related to LS from January 2005 to December 2007. Descriptive analyses and binary logistic regression models were used to analyze the data.  RESULTS: The total of 24,175 hospitalizations (3.52%) was operated with LS. The proportion of CSMBS patients undergoing LS (7.8%) was higher than that of UC patients (2.68%). It was found that diseases of gallbladder and cholecystitis, diseases of gynaecology and acute appendicitis were the most diseases performing LS in Thailand. The provision of LS was significantly associated with age, sex, principal diagnosis, admission year, type of hospitals and type of health insurance coverage. Patients with CSMBS were about two or three times more likely to undergo LS compared to UC. Type of health insurance was the most significant factor associated with the use of LS.  CONCLUSIONS: There is an unequal access to LS among patients owing to both medical and non-medical indications. Health insurance coverage plays a significant role in LS provision in Thailand.