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Southern and Southeast Asian emerging economies are undergoing profound transformations. These shifts are propelled by demographic transitions, economic growth, social development, technological innovation, and evolving public expectations toward healthcare. Rapid population ageing, a surge in non-communicable diseases (NCDs), disparities in healthcare access, and persistent underfunding present complex challenges. However, governments in this region are responding with innovative health financing models, digital transformation, a renewed focus on preventive care, and strategic reforms to improve health outcomes and system resilience.

Population Ageing: The Silent Tsunami

Asia is home to the world’s fastest-growing elderly population. By 2050, an estimated 1.3 billion Asians—one in every four people—will be aged 60 or older. The ASEAN region alone is expected to witness its elderly population rise from 77.4 million (11.5% of the population) in 2020 to 173.3 million (22.0%) by 2050. Countries like India and Thailand are seeing a marked increase in their older citizenry, with India’s over-60 population projected to double by 2050. This rapid demographic transition brings heightened occurrences of comorbid conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases, and dementia.

Surge of Non-Communicable Diseases (NCDs)

Alongside ageing, NCDs are becoming the preeminent health challenge. The World Health Organization estimates that 62% of all deaths in Southeast Asia are due to NCDs—mainly cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. As traditional infectious diseases decline, the health agenda is rapidly shifting toward the management of long-term chronic illnesses, nutrition, and mental health.

Unmet Needs and Health Inequities

While life expectancy has risen and child and maternal mortality rates have declined, the overall health landscape remains uneven. Vast disparities persist between and within countries—especially between rural and urban areas and among different socioeconomic groups. Many older adults lack access to specialized or institutional care, while health facility availability and affordability are often limited outside major urban centers.

Mixed Public-Private Model

Most countries in Southern and Southeast Asia operate a dualistic health system blending public and private providers. Private healthcare often delivers high-quality services but remains unaffordable for many, and is concentrated in urban centers, while public systems provide subsidized (or free-at-point-of-use) healthcare but struggle with funding, infrastructure, and workforce limitations.

Health Financing Landscape

• India: Predominantly mixed financing, with increasing government investment. However, out-of-pocket (OOP) spending remains significant, contributing to high rates of catastrophic health expenditure.

• Indonesia: The government’s Jaminan Kesehatan Nasional (JKN) scheme now covers over 95% of the population, sharply reducing OOP burdens.

• Malaysia: A highly subsidized public system, yet persistent gaps in specialist services and rural coverage.

• Philippines: Income-dependent insurance, with PhilHealth striving for universal coverage but facing both resource and consistency issues.

• Thailand: A robust Universal Coverage Scheme (UCS), fully tax-funded, offering nearly cashless comprehensive care, but contending with long-term fiscal sustainability.

Healthcare systems in all these countries are grappling with underinvestment relative to growing demand and rising costs.

1. Improving Government Healthcare Financing

After Years of Chronic Underfunding…

• Indonesia’s JKN UHC program reduced catastrophic health expenditure from 4.5% to 2% of current health expenditure between 2017 and 2021.

• Malaysia increased its health budget allocation by 10% in 2025 to RM45.3 billion, focusing on upgrading rural healthcare infrastructure, yet remains below the recommended 5% of GDP target for health spending.

• India improved government health expenditure from 29% to 48% of total health spending between 2015 and 2025, notably through schemes like Ayushman Bharat—PMJAY.

Yet, healthcare inflation outpaces general inflation, widening the funding gap. While budgets are rising, demand is rising faster, especially as countries grapple with demographic transitions and chronic disease management.

2. Harnessing the Digital Revolution

Digital transformation is central to overcoming access, efficiency, and quality challenges:

• India: The Ayushman Bharat Digital Mission (ABDM) is creating an interoperable digital ecosystem with health accounts for hundreds of millions and seamless data exchange across providers. E-Sanjeevani, the world’s largest telemedicine platform, offers remote consultations to over 360 million patients.

• Thailand: From 2025, Thailand’s UHC program offers each citizen a digital health ID, enabling one-click access to complete medical records, appointments, referrals, and pharmacy services.

• Malaysia: Ongoing rollout of electronic medical records and investments in the Ministry of Health’s IT systems to digitalize clinics and improve interoperability.

• Indonesia: Transform Health Indonesia, a sweeping initiative, aims for a fully integrated, digital-first primary healthcare system by 2030, including electronic patient health records.

• Philippines: The Department of Health is pushing for the interoperability of digital information systems.

Telemedicine, AI-enabled analytics, mobile health apps, and cloud-based administrative platforms are streamlining care, supporting remote diagnostics, and addressing workforce shortages, especially in underserved areas.

3. Wellness and Preventive Care

Health policies are progressively shifting from a curative to a preventive and promotive stance:

• Indonesia’s Pemeriksaan Kesehatan Gratis (PKG): An annual, nationwide NCD screening for all citizens, backed by substantial government funding.

• India’s RBSK and RKSK schemes: Target child and adolescent health, screening for congenital, chronic, or developmental conditions.

• Malaysia: Collaborative programs with WHO focus on educating communities about health risks and encouraging early intervention through preventive screenings and lifestyle modification.

• Thailand: A booming “wellness economy” offers comprehensive preventive care—including longevity, fertility, and cognitive wellness services—with an emphasis on health tourism.

These programs aim to reduce disease burden before costly medical intervention is necessary.

4. Special Focus on Elderly Care

The accelerating growth of the aged brings new care requirements:

• India: The Pradhan Mantri Jan Arogya Yojana now covers all seniors age 70+ for up to ₹5 lakh in medical expenses per year, regardless of income.

• Malaysia: The Bantuan Keluarga Malaysia scheme includes new cash aid for older adults.

• Thailand: Despite an exemplary UHC program, gaps remain in long-term and institutional elder care—a sector ripe for further investment.

Countries are exploring new business and insurance models for aged care, but policy coverage and institutional care infrastructure remain limited.

India

India’s system spans a vast public-private network. Despite reforms and rising government investment, chronic gaps persist:

• Urban areas enjoy advanced tertiary and private care; rural areas often have basic facilities and skill shortages.

• Recent advances include digitization, the promotion of affordable medical devices, and government-backed financial protection for the poor.

• Critical schemes (e.g., PMJAY, JSSK, RBSK, RAN, HMCPF) have successful track records in expanding coverage and quality—yet, uneven access and insufficient insurance for the middle class endure.

Thailand

Thailand’s model blends UHC with a vibrant private sector:

• Public funding covers 99.5% of residents at virtually no out-of-pocket cost.

• Focus areas include digitalization, expansion of mental and elderly services, and robust rural healthcare outreach.

• However, the cost of comprehensive coverage is rising, and there are warnings about long-term fiscal sustainability.

Malaysia

Malaysia’s dual public-private structure is a hallmark:

• The public sector (government hospitals and clinics) is heavily subsidized, servicing over 65% of the population, with the private sector largely catering to urban and higher-income groups.

• Investment in medical tourism is significant.

• Persistent workforce shortages, especially for specialists, and access disparities—particularly in rural areas—are key ongoing challenges.

Indonesia

Indonesia’s healthcare is administratively decentralized:

• The JKN UHC program has succeeded in coverage but faces difficulties in quality and consistent access between urban and rural facilities.

• Primary care services are delivered via PUSKESMAS centers, but public hospitals in rural regions require infrastructure upgrades and better funding.

Philippines

PhilHealth strives to expand universal coverage:

• Inequities continue between public (less reliable, especially in rural settings) and private (higher-quality, urban-focused) systems.

• Affordability, accessibility, and consistent funding remain problematic even as new, patient-centered insurance benefit packages are introduced.

Healthcare Financing Gaps

Despite commendable increases in public health spending, current financing remains inadequateto address rising demographic and disease pressures. Healthcare inflation, outpacing ordinary inflation by up to threefold, leads to unsustainable increases in care costs. For example, Malaysia would need to double its current allocation to reach the recommended 5% of GDP threshold, highlighting severe underinvestment.

Inequitable Access and Rural-Urban Divide

Infrastructure, quality of care, and workforce distribution are skewed toward urban centers. Rural and less affluent regions frequently suffer from:

• Poor facility infrastructure.

• Shortages of qualified healthcare professionals.

• Limited specialist and digital resources.
  This divide aggravates health inequities and undermines system goals for universal access.

Underdeveloped Preventive and Long-Term Care

While investment in preventive health is growing, curative services still dominate budgets and strategic planning. Preventive and wellness programs are often new, fragmented, or inadequately funded. Elderly and institutional care—especially for chronic, high-need conditions—are particularly underdeveloped, with major gaps persisting even in otherwise robust UHC models.

Out-of-Pocket Expenditures

High OOP spending for medicines, diagnostics, and long-term care remains an issue, exposing many households to catastrophic health expenses despite advances in insurance coverage.

Digital Divide

Digital health solutions can only be effective if access and literacy are universal. Limited access to digital infrastructure or low digital literacy—especially among the elderly and rural populations—pose ongoing challenges.

1. Strengthen Public-Private Partnerships and Governance

• Corporatization of public health services can help drive efficiency while preserving equity.

• The private sector—from hospitals to insurers, and increasingly, digital health startups—should be integrated into national health strategies, both as care providers and innovation partners.

• Governments can use regulatory bodies or public-private commissions to review and cap patient charges, especially to manage OOP in private facilities.

2. Integrated Care and Digital Health Ecosystems

• To move away from fragmented, siloed care, countries must build integrated systems in which data, patients, and providers flow seamlessly across levels (primary, secondary, tertiary) and sectors.

• Interoperability standards and universal digital health IDs will facilitate this, enhancing coordination, continuity, and personalized care.

• Workforce digital literacy training will be crucial, and digital innovations (AI analytics, telehealth, self-management platforms) must be user-friendly and culturally tailored.

3. Boost Investments in Preventive, Wellness, and Long-Term Care

• Consistent financing and scale-up of population-wide screening, health education, vaccination, and lifestyle intervention programs are vital.

• Governments can harness the wellness tourism sector, as in Thailand, to build a business infrastructure for preventive service delivery that also benefits domestic populations.

• Policymakers must devise sustainable funding and insurance packages specifically for the elderly and those with chronic needs—bridging the current gap in institutional and home-based care.

4. Data-Driven Policy and Research Capacity

• Enhanced health information systems will allow better tracking of disease patterns and policy effectiveness, supporting more adaptive, evidence-based strategies.

• Investment in local clinical and policy research is necessary for sustainable, context-sensitive solutions.

5. Equity-Focused Policies

• Targeted policies to address rural-urban, gender, and age-based inequities.

• Direct subsidies, conditional cash transfers, and location-targeted resource allocation can help close present gaps.

The health systems of India, Indonesia, Malaysia, the Philippines, and Thailand are at a critical juncture—marked by dynamic social, economic, and epidemiological transitions. Population ageing, the rapid rise of NCDs, and persistent disparities in healthcare funding and access present formidable obstacles. Nevertheless, a new wave of public investment, policy innovation, digital transformation, and preventive health emphasis holds promise for more equitable, resilient, and patient-centered healthcare.

To successfully navigate the coming decades, these nations must transform their health systems into integrated, digitally powered networks; prioritize investments in prevention, long-term, and elder care; deepen public-private collaboration; and ensure health equity is at the heart of all reforms. Only then can the promise of universal health coverage—and healthier, more prosperous societies—be fully realized in Southern and Southeast Asia.