The Strategic Role of Private Health Insurance (PHI) for Health System Goals and to Advance Universal Health Coverage

    The Strategic Role of Private Health Insurance (PHI) for Health System Goals and to Advance Universal Health Coverage

    The Regional Knowledge Event is a regular meeting organized by ANHSS, serving as a discussion forum for policymakers, legislators, practitioners, industry players, and academics across the region. This May 2025 event was attended by over 120 participants from eight countries in Asia.

    Opening Session

    Opening remarks were delivered by Professor Philip Wai-Yan Chiu, Dean of the Faculty of Medicine at The Chinese University of Hong Kong; Professor Samuel Yeung-Shan Wong, Director of the JC School of Public Health and Primary Care at the same university; and Professor Dr. Laksono Trisnantoro from Universitas Gadjah Mada, Indonesia.

    The speakers highlighted that Universal Health Coverage (UHC) principles underpin efforts to integrate resources between the public and private sectors. The private sector was recognized as a crucial partner to government efforts, serving as both a supplementary and complementary mechanism to public systems. This event focused particularly on the role of Private Health Insurance (PHI).

    Morning Session

    The morning session featured several keynote speeches exploring the role of PHI from various perspectives including academia, policy, and industry.

    Professor Eng-Kiong Yeoh emphasized that insurance is essentially about pooling risk and cost to distribute financial burden and protect individuals. He described four different pooling models:

    1. No pooling, where individuals pay out-of-pocket;
    2. Unitary pooling, where all funds and risks are combined in one national pool (e.g., Indonesia);
    3. Fragmented pooling, where risk is separated by geography, risk group, or population (e.g., Germany, the UK, Thailand); and
    4. Integrated pooling, where funding can shift across pools in exceptional circumstances.

    He reiterated the importance of PHI as a supplementary and complementary solution to public financing schemes.

    From a regulatory perspective, Mr. Clement Lau Chung-Kin of the Insurance Authority (Hong Kong) stated that the government holds a dual mandate: to protect the public while also ensuring a sustainable insurance industry. Insurance, he emphasized, also shapes societal behavior and individual decision-making.

    Mr. Sam Hui, JP, Deputy Secretary for Health, explained that only 30% of private healthcare financing in Hong Kong is covered by PHI, with 60% still paid out-of-pocket (OOP). He noted that there is a significant untapped market for PHI, but also outlined strict requirements imposed by regulation:

    • Plans must be renewable up to age 100
    • There must be no lifetime claim cap
    • Pre-existing conditions must be covered starting from the second year
    • Benefits must expand progressively from year four

    In addition, the government demands price transparency and efforts to reduce information asymmetry. However, consolidated PHI data remains limited, prompting the government to initiate regular dialogues with the industry.

    Dr. Eduardo Banzon from the Asian Development Bank reminded participants that the “universal” in UHC means everyone should have access to the health services they need. Across Asia, many countries are shifting service provision to the private sector, except where private actors are deliberately restricted. He noted that in countries where population coverage under UHC is not yet achieved, PHI might act as a substitute. However, this is not ideal from a public finance perspective, as it could erode revenue from national insurance pools.

    Instead, PHI should function as a complementary and supplementary solution—expanding service coverage and improving financial protection. He shared that in the Philippines, voluntary PHI is non-taxable and only available to PhilHealth members, making it attractive to the middle- and lower-middle-income groups. Indonesia, he added, once implemented Coordination of Benefits (CoB), but the policy was paused in 2020.

    Mr. Alger Fung, CEO of AIA Hong Kong and Macau, provided the industry perspective, emphasizing that PHI not only offers health protection but also contributes to public health promotion. AIA, for example, provides premium discounts to customers who improve their health metrics, creates public parks, and runs free wellness programs like yoga, boxing, and tennis classes.

    Professor Jeremy Lim from Singapore described a multi-tiered insurance system built to serve both the general population and high-income or expatriate communities. The Singaporean model includes:

    • MediFund for individuals unable to pay OOP
    • Top-up programs such as Medisave
    • MediShield, reformed in 2005, now covers about 90% of the population
    • HealthierSG, launched in 2023, supports preventive care with an annual public budget of SGD 5 billion

    PHI in Singapore fills gaps for individuals not covered under MediShield, including non-citizens, estimated at around 2.4 million people.

    Panel Discussion

    The session concluded with a panel discussion moderated by Dr. Libby Ha-Yun Lee, Under Secretary for Health, Health Bureau (HKSAR, China). Panelists emphasized the importance of strong regulations, governance capacity, and data infrastructure to support PHI’s contribution to national health systems. Transparent, accountable systems are essential to allow data sharing for policy development and monitoring.

    Afternoon Session: Industry and Country Experiences

    In the afternoon keynote, Professor Soonman Kwon from Seoul National University discussed how PHI operates under South Korea’s universal public insurance system. In Korea, PHI acts as a “fiscal valve” for the public scheme by covering co-payments and services not included in the national plan. This results in increased use of both private and publicly reimbursed services.

    Healthcare providers in Korea often engage in bundling of services that are covered and not covered by public insurance, which contributes to higher overall utilization.

    Dr. Yat Chow from BUPA noted that in Hong Kong, PHI is most frequently used for outpatient services, especially in primary care, including both Traditional Chinese Medicine (TCM) and Western Medicine. Out-of-pocket payments still dominate, although Hong Kong’s health system reflects a relatively balanced public–private financing blend.

    For example, HK$29 billion in outpatient care is financed by individuals, while HK$6.8 billion comes from the government. In fiscal year 2023, public health expenditure reached HK$150.4 billion (58%), and private expenditure stood at HK$109.7 billion (42%).

    Country Experiences: Thailand, Malaysia, and Indonesia

    The session continued with presentations from Thailand, Malaysia, and Indonesia.

    In Thailand, Professor Chantal Herberholz explained that PHI generally takes two forms: individual plans for high-income groups and group plans tied to formal employment or companies. This dual structure also exists in Indonesia and Malaysia, where PHI operates independently from healthcare providers.

    By contrast, Hong Kong features integrated entities that act as both insurers and providers, enabling them to influence both financing and care delivery.

    In the Indonesian context, Professor Laksono identified two major challenges in public health insurance: equity and sustainability. Claims are disproportionately high in major urban centers with advanced infrastructure, creating disparities in access. At the same time, consistently high claim ratios strain the public insurance system’s financial sustainability. Claims fell during the COVID-19 pandemic due to reduced service utilization but have since risen again, contributing to a widening deficit.

    In Malaysia, Professor Sharifa described the rapid growth of private healthcare and PHI, supported by strong demand and the country’s medical tourism sector. PHI is regulated by the Central Bank of Malaysia, ensuring financial oversight. However, medical inflation and increasing utilization have driven PHI premiums upward. Projections indicate that premiums may rise by 40% to 70% by 2025.

    Conclusion

    This regional knowledge exchange revealed both the diversity and similarity in approaches to private health insurance across Asia. While models vary by country, all agree that PHI—when effectively regulated and integrated—can serve as a strategic enabler for achieving Universal Health Coverage and sustainable health system goals.

     

    Sistem kesehatan di seluruh dunia menghadapi tekanan luar biasa akibat penuaan populasi dan meningkatnya biaya layanan kesehatan, yang mengancam stabilitas keuangan nasional dan daerah. Para pembuat kebijakan yang berupaya memperkuat sistem kesehatan mencari mekanisme pembiayaan alternatif untuk memastikan akses yang adil terhadap layanan kesehatan. Hal ini menimbulkan pertanyaan: Dapatkah Asuransi Kesehatan Swasta (PHI) mengisi kesenjangan dan membantu sistem kesehatan dalam mencapai Cakupan Kesehatan Semesta (UHC)? Topik penting ini akan dibahas dalam Regional Knowledge Event bertajuk "Peran Strategis Asuransi Kesehatan Swasta (PHI) untuk Tujuan Sistem Kesehatan dan Memajukan Cakupan Kesehatan Semesta," yang akan diadakan pada Rabu, 7 Mei 2025, di Hong Kong. Acara ini diselenggarakan oleh Asia-Pacific Network for Health Systems Strengthening (ANHSS) bekerja sama dengan Centre for Health Systems and Policy Research di Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong.

    Latar Belakang

    Pembiayaan kesehatan publik, seperti sistem berbasis pajak atau Asuransi Kesehatan Sosial (Social Health Insurance - SHI), memainkan peran penting dalam sistem kesehatan global dengan memastikan cakupan luas dan perlindungan keuangan. Di sisi lain, Asuransi Kesehatan Swasta (PHI), yang dibeli secara individu untuk melengkapi, mendukung, atau menggantikan mekanisme pembiayaan publik, juga berkontribusi dalam mengurangi risiko keuangan dan meningkatkan akses layanan kesehatan. Meskipun skema pembiayaan publik menyediakan cakupan dasar, meningkatnya permintaan akan solusi pembiayaan inovatif telah meningkatkan perhatian terhadap PHI sebagai alat potensial untuk mendukung sistem publik dan memperluas akses layanan kesehatan. Namun, peran PHI dalam mencapai tujuan sistem kesehatan dan UHC masih menjadi perdebatan penting. 

    Salah satu tujuan sistem kesehatan sebagaimana yang ditetapkan dalam Sustainable Development Goals (SDGs) PBB, Target 3.8, adalah Cakupan Kesehatan Semesta (UHC), yang didefinisikan sebagai "akses ke seluruh layanan kesehatan berkualitas, kapan dan di mana pun dibutuhkan, tanpa kesulitan finansial." Meskipun UHC menjadi prioritas global, kemajuannya telah mengalami stagnasi bahkan sebelum pandemi COVID-19. Di negara-negara OECD, belanja kesehatan diproyeksikan tumbuh sebesar 2,6% per tahun, lebih cepat dari pertumbuhan pendapatan pemerintah yang hanya 1,3%, sehingga menimbulkan kekhawatiran tentang keberlanjutan keuangan.

    Sementara itu, tren global seperti penuaan populasi dan meningkatnya penyakit kronis serta tidak menular menambah tekanan pada sistem kesehatan agar dapat memberikan layanan yang tepat waktu dan merata. Sistem pembiayaan tunggal seperti SHI memang memberikan perlindungan dasar, namun banyak negara menghadapi defisit fiskal yang semakin meningkat, dengan suntikan anggaran tambahan yang diperlukan untuk menjaga keberlanjutan keuangan. Akibatnya, para pembuat kebijakan di seluruh dunia mengeksplorasi pendekatan pembiayaan kesehatan yang inovatif dan pelengkap. PHI semakin mendapat perhatian karena potensinya untuk mengurangi beban sektor publik, meningkatkan akses layanan kesehatan, dan mengurangi biaya langsung (out-of-pocket costs) bagi individu. Dengan mempertimbangkan tantangan dan peluang ini, diskusi mendalam mengenai peran PHI dalam mencapai tujuan sistem kesehatan dan UHC menjadi sangat penting dan relevan.

    Gambaran Acara

    Acara ini akan memberikan pemahaman menyeluruh tentang peran strategis PHI dalam konteks tujuan sistem kesehatan di kawasan Asia-Pasifik, dengan menghadirkan wawasan dan pengalaman dari akademisi senior, pembuat kebijakan, regulator, ekonom, dan pelaku industri asuransi.
    Para peserta akan berpartisipasi dalam diskusi mengenai:

    • Prinsip Cakupan Kesehatan Semesta – Memahami UHC, perspektif para pemangku kepentingan, serta upaya kolektif dalam mencapainya.
    • Health System Goals, Population Needs and Patient Perspectives – Exploring how different health system designs address common challenges.
    • Peran Strategis Asuransi Kesehatan Swasta – Menganalisis bagaimana PHI dapat melengkapi dan mendukung skema nasional yang sudah ada.
    • Lingkungan Bisnis dan Regulasi – Membahas persyaratan yang diperlukan agar PHI dapat berfungsi sebagai alat pembiayaan yang berkelanjutan.
    • Studi Kasus dari Asia-Pasifik – Mempelajari pengalaman spesifik dari berbagai negara dan praktik terbaik dalam penerapan PHI.

    Acara ini akan menjadi platform unik bagi para pemangku kepentingan utama untuk bertukar pengetahuan, berbagi strategi, dan mengeksplorasi pendekatan berbasis bukti dalam memanfaatkan PHI untuk mendukung UHC.

    Tujuan Acara

    Acara ini bertujuan untuk:

    1. Menganalisis peran PHI dalam mencapai tujuan sistem kesehatan dan UHC di kawasan Asia-Pasifik.
    2. Mengkaji kebutuhan dan tantangan sistem kesehatan dari perspektif berbagai pemangku kepentingan, termasuk pembuat kebijakan, regulator, ekonom, dan industri asuransi.
    3. Mengeksplorasi berbagai model pembiayaan kesehatan, kelebihan, keterbatasan, dan potensi sinerginya dengan PHI.
    4. Mendorong pertukaran pengetahuan tentang strategi untuk mengatasi tekanan finansial dalam layanan kesehatan sambil menjaga aksesibilitas dan kesetaraan.
    5. Mendiskusikan kebijakan dan kerangka regulasi yang diperlukan untuk memastikan kontribusi PHI yang berkelanjutan dalam pembiayaan kesehatan.
    6. Menyajikan studi kasus nyata yang menggambarkan pengalaman berbagai negara dan pelajaran dalam mengintegrasikan PHI ke dalam sistem kesehatan.

    Pembicara dan Tamu Undangan 

    • Dr. Eduardo P. BANZON (Director, Health Sector Group, Asian Development Bank, Philippines)
    • Professor Ying-Yao CHEN (Professor, Fudan University, China)
    • Mr. Clement CHEUNG (CEO, Insurance Authority, Hong Kong SAR, China)
    • Professor Philip Wai-Yan CHIU (Dean of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China)
    • Dr. Yat CHOW (Executive Medical Director, Bupa HK, Hong Kong SAR, China)
    • Shita DEWI (Divisi Kebijakan Kesehatan dan Kesehatan Masyarakat, CHPM, Universitas Gadjah Mada, Indonesia)
    • Dr. FUNG Hong, Executive Director and CEO of CUHK Medical Centre, HKSAR, China) 
    • Professor Chantal HERBERHOLZ (Professor, Chulalongkorn University, Thailand)
    • Mr. Sam HUI (Deputy Secretary for Health 1, Health Bureau, Hong Kong SAR, China)
    • Professor Soonman KWON (TBC) (Professor, Seoul National University, South Korea)
    • Dr. Libby Ha-Yun LEE (Under Secretary for Health, Health Bureau, Hong Kong SAR, China)
    • Ms. Sarah LEONG (TBC) (Director, Finance Partnerships and Governance, Ministry of Health, Singapore)
    • Professor Chung-Mau LO (TBC) (Secretary for Health, Health Bureau, Hong Kong SAR, China) 
    • Profesor Siripen SUPAKANKUNTI (Profesor, Universitas Chulalongkorn, Thailand)
    • Professor Laksono TRISNANTORO (Professor, Universitas Gadjah Mada, Indonesia)
    • Professor Sharifa Ezat WAN PUTEH (Professor, Universiti Kebangsaan Malaysia, Malaysia)
    • Professor Samuel Yeung-Shan WONG (Director, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China)
    • Professor Eng-Kiong YEOH (Director, Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong SAR, China)

    Sasaran Peserta

    • Pembuat kebijakan, regulator, ekonom kesehatan, perusahaan asuransi, penyedia layanan kesehatan, dan peneliti yang terlibat dalam penguatan sistem kesehatan dan pembiayaan.
    • Pejabat pemerintah yang menangani kebijakan kesehatan, pemangku kepentingan asuransi kesehatan swasta, serta organisasi internasional yang berfokus pada pencapaian UHC.
    • Profesional dari lembaga multilateral, administrator rumah sakit, dan kelompok advokasi pasien yang ingin memahami strategi pembiayaan kesehatan inovatif serta peran PHI dalam melengkapi sistem kesehatan publik.

    Waktu dan Tempat

    Tanggal: Rabu, 7 Mei 2025
     Waktu: 09.00 – 17.30 (GMT+8)
     Lokasi: Alva Hotel by Royal, 1 Yuen Hong Street, Shatin, Hong Kong

    Registrasi

    Acara ini hanya terbuka bagi peserta undangan. Partisipasi tambahan dapat diatur berdasarkan ketersediaan.

    Untuk informasi lebih lanjut, silakan hubungi Ms. Ho Yee MIAO di +852 2252 8783 (hoyeemiao@cuhk.edu.hk.).

    The Strategic Role of Private Health Insurance (PHI) for Health System Goals and to Advance Universal Health Coverage

    Event Date: 9:00 am – 5:30 pm, May 7th, 2025
    Lokasi: Alva Hotel by Royal, 1 Yuen Hong Street, Shatin, Hong Kong

    8:30 AM – 9:00 AM | Registration 

    9:00 AM – 9:30 AM

    Welcome

    Professor Philip Wai-Yan CHIU, Dean of Medicine, The Chinese University of Hong Kong (HKSAR, China) Professor Samuel Yeung-Shan WONG, Director, JC School of Public Health and Primary Care, The Chinese University of Hong Kong (HKSAR, China)

    Professor Laksono TRISNANTORO, Professor of Health Policy and Management, Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (Indonesia)

    Word of Thanks

    Professor Eliza Lai-Yi WONG, Associate Director (Research), Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong (HKSAR, China)

    Session 1: Overview & Challenges

    09:30 AM – 10:00 AM 
    Topic: Review of the Role of PHI and Challenges in the Global Context
    Speaker: Professor Eng-Kiong YEOH, Director, Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong (HKSAR, China)

     

    Session 2: Strategic Role of PHI for Health System Goals: Keynotes

    Dr. Libby Ha-Yun LEE, Under Secretary for Health, Health Bureau (HKSAR, China) 

    10:00 AM – 10:25 AM | Keynote Speech 1

    Topic: Strategic Roles of PHI: Regulation and Government Perspective

    Speaker: Mr. Clement LAU Chung-Kin, Executive Director, Policy and Legislation Division, Insurance Authority (HKSAR, China)

     10:25 AM – 10:50 AM | Keynote Speech 2

    Topic: Voluntary Health Insurance Scheme in Hong Kong

    Speaker: Mr. Sam HUI, JP, Deputy Secretary for Health 1, Health Bureau (HKSAR, China)

    10:50 AM – 11:10 AM    Tea break

    11:10 AM – 11:35 AM | Keynote Speech 3

    Topic: Strategic Roles of PHI for Universal Health Coverage

    Speaker: Dr. Eduardo P. BANZON (Dodo), Director, Health Sector Group, Asian Development Bank (Philippines)

    DOWNLOAD

    11:35 AM – 12:00 PM | Keynote Speech 4

    Topic: Role of Health Insurance from Insurers’ Perspectives Contributing to Health System Goals

    Speaker: Mr. Alger FUNG, Chief Executive Officer, AIA Hong Kong and Macau (HKSAR, China)

    12:00 PM – 12:25 PM | Keynote Speech 5

    Topic: Strategic Role of PHI for Health System Goals in Singapore

    Speaker: Professor Jeremy LIM, Associate Professor (Adjunct), Saw Swee Hock School of Public Health, National University of Singapore (Singapore)

    12:25 PM – 1:00 PM | Panel Discussion

    • Ms Gilly Fung-Han WONG, Chief Executive, Consumer Council (HKSAR, China)
    • Clement LAU Chung-Kin (Executive Director, Policy and Legislation Division, Insurance Authority (HKSAR, China)
    • Sam HUI, JP, Deputy Secretary for Health 1, Health Bureau (HKSAR, China)
    • Eduardo P. BANZON (Dodo), Director, Health Sector Group, Asian Development Bank (Philippines)
    • Professor Jeremy LIM, Associate Professor (Adjunct), Saw Swee Hock School of Public Health, National University of Singapore (Singapore)

    1:00 PM – 2:15 PM    Lunch break

     

    Session 3: Strategic Role of PHI in Advancing UHC: Industry and Country Experiences

    Keynote Speech

    2:15 PM – 2:40 PM | Keynote Speech 6

    Topic: Private Health Insurance under Universal Public Health Insurance System
    Speaker: Professor Soonman KWON, Professor, Seoul National University (South Korea)
    DOWNLOAD

    Perspectives from Industry (Insurers, Pharmaceutical Manufacturers and Providers) 

    2:40 PM – 3:00 PM

    Topic: Health Insurer’s Perspective: Bupa
    Speaker: Dr. Yat CHOW, Executive Medical Director, Bupa HK (HKSAR, China) 

    3:00 PM – 3:30 PM | Round Table Discussion: Insurers, Pharmaceutical Manufacturers and Providers

    Professor. Hong FUNG, Executive Director and CEO of CUHK Medical Centre; Professor of Practice of JC School of Public Health & Primary Care (HKSAR, China)

    • Yat CHOW, Executive Medical Director, Bupa HK (HKSAR, China)
    • Wing CHAN, Chief Medical Services Officer, HSBC Life (HKSAR, China)
    • Ada LEE, External Affairs Director, Merck Sharp & Dohme (Asia) Limited (HKSAR, China)
    • Florence LEE, Patient Access & Public Affairs Lead, Roche Hong Kong Limited (HKSAR, China)
    • SunKeun HUH, General Manager, Johnson & Johnson (Hong Kong) Limited (HKSAR, China)

    3:30 PM – 3:45 PM    Tea break

     

    Session 4: Country Experiences in the Development of PHI

    3:45 PM – 5:00 PM 

    Topic: Private Health Insurance in China: Progress, Gaps, and Paths Forward
    Speaker: Professor Yingyao CHEN, Deputy Dean, School of Public Health, Fudan University (China) 
    DOWNLOAD

    Topic: The Role of Private Health Insurance in Achieving UHC in the Philippines
    Speaker: Professor Maria Elena B. HERRERA, Adjunct Faculty of Asian Institute of Management, Makati City, Metro Manila (The Philippines) 
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    Topic: Country Experiences in the Development of PHI: Thailand
    Speakers: Professors Siripen SUPAKANKUNTI, Professor, Centre of Excellence for Health Economics, & Professor Chantal HERBERHOLZ, Director, Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok (Thailand)
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    Topic: Indonesia’s Private Health Insurance Current Situation
    Speaker: Professor Laksono TRISNANTORO, Professor of Health Policy and Management, Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (Indonesia)
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    Topic: Malaysia’s Experience with Health Insurance
    Speaker: Professor Dr. Sharifa Ezat WAN PUTEH, Professor of Public Health, Department of Community Health, Universiti Kebangsaan Malaysia (Malaysia)
    DOWNLOAD

     

    Discussion and Closing

    5:00 PM – 5:30 PM

    Professor Eng-Kiong YEOH, Director, Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong (HKSAR, China)

    • Professor Soonman KWON, Professor, Seoul National University (South Korea)
    • Professor Yingyao CHEN, Deputy Dean, School of Public Health, Fudan University (China)
    • Professor Maria Elena HERRERA, Adjunct Faculty of Asian Institute of Management, Makati City, Metro Manila (The Philippines)
    • Professor Siripen SUPAKANKUNTI, Professor, Centre of Excellence for Health Economics, &
    • Professor Chantal HERBERHOLZ, Director, Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok (Thailand)
    • Professor Laksono TRISNANTORO, Professor of Health Policy and Management, Department of Health 

    Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Universitas Gadjah Mada (Indonesia)

    • Professor Sharifa Ezat WAN PUTEH, Professor of Public Health, Department of Community Health, Universiti Kebangsaan Malaysia (Malaysia)