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.

     

    Health systems worldwide are under unprecedented strain from population aging and rising healthcare costs that threaten national and jurisdictional financial security. Policymakers looking to strengthen healthcare systems are seeking alternative financing mechanisms to provide equitable access to care, which begs the question: Can Private Health Insurance fill the gaps and facilitate health systems to advance Universal Health Coverage? Bringing together a diverse range of speakers representing government, regulators, insurers, academia, and healthcare business community, this critical topic will be discussed at our upcoming Regional Knowledge Event, “The Strategic Role of Private Health Insurance (PHI) for Health System Goals to Advance Universal Health Coverage,” scheduled for Wednesday, May 7, 2025, in Hong Kong. This event is organised by the Asia-Pacific Network for Health Systems Strengthening (ANHSS) in collaboration with the Centre for Health Systems and Policy Research at the Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong. 

    Background

    Public health financing, such as tax-based system or Social Health Insurance (SHI), plays a critical role in health systems worldwide by ensuring broad population coverage and financial protection. In parallel, Private Health Insurance (PHI), purchased by individuals to supplement, complement, or substitute public health financing mechanisms, also contributes to mitigating financial risks and improving access to healthcare. While public financing schemes provide essential coverage, the growing demand for innovative financing solutions has brought increased attention to PHI as a potential tool to support public systems and expand healthcare access. However, its role in advancing health system goals and Universal Health Coverage remains a critical question. 

    One health system goal as outlined by the United Nations Sustainable Development Goals (Target 3.8) is Universal Health Coverage (UHC), defined as “access to the full range of quality health services, when and where people need them, without financial hardship”. Despite its global importance, progress toward UHC has stagnated even before the COVID-19 pandemic. Among OECD countries, health expenditures are projected to grow at 2.6% annually, outpacing government revenue growth at 1.3%, raising concerns about financial sustainability.

    At the same time, global trends such as aging populations and rising chronic and non-communicable diseases are increasing pressure on health systems to deliver timely and equitable services. While single-payer systems like SHI provide a foundational safety net, many face growing fiscal deficits, with budget injections needed to maintain solvency threatening national financial stability. As a result, policymakers worldwide are exploring innovative and supplementary health financing approaches. PHI has gained attention for its potential to ease public-sector burdens, improve access to care, and reduce out-of-pocket costs. Given these challenges and opportunities, a critical discussion on PHI’s role in achieving health system goals and advancing UHC is both timely and necessary.

    Event overview

    This event will provide a comprehensive overview of PHI’s strategic role in the context of health system goals across the Asia-Pacific region, featuring insights and experiences from senior academics, policymakers, regulators, economists, and insurers. Participants will engage in discussions on:

    • Principles of Universal Health Coverage – Understanding UHC, stakeholder perspectives, and collective efforts toward its advancement.
    • Health System Goals, Population Needs and Patient Perspectives – Exploring how different health system designs address common challenges.
    • The Strategic Role of Private Health Insurance – Examining how PHI complements and supplements existing national schemes.
    • Business and Regulatory Environments – Addressing the requirements for PHI to function as a sustainable financing tool.
    • Case Studies from the Asia-Pacific – Learning from country-specific experiences and best practices.

    This event provides a unique platform for key stakeholders to exchange knowledge, share strategies, and explore evidence-based approaches to leveraging PHI in support of UHC.

    Objectives

    This Knowledge Event aims to:

    1. Examine the role of PHI in achieving health system goals, and in the context of UHC across the Asia-Pacific region.
    2. Analyze health system needs and challenges from the perspectives of multiple stakeholders, including policymakers, regulators, economists, and insurers.
    3. Explore different health financing models, their strengths, limitations, and potential synergies with PHI.
    4. Facilitate knowledge exchange on strategies to address financial pressures in healthcare while maintaining accessibility and equity.
    5. Discuss policy and regulatory frameworks necessary to ensure PHI’s sustainable contribution to health financing.
    6. Present real-world case studies to illustrate diverse country experiences and lessons learned in integrating PHI into health systems.

    Invited Guests and Speakers 

    • 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 (Health Policy and Public Health Division, 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) 
    • Professor Siripen SUPAKANKUNTI (Professor, Chulalongkorn University, 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)

    Target Audience

    This Regional Knowledge Event is designed for policymakers, regulators, health economists, insurers, healthcare providers, and researchers engaged in health system strengthening and financing. It is particularly relevant for government officials overseeing health policy, private health insurance stakeholders, and international organizations working toward Universal Health Coverage (UHC). Additionally, professionals from multilateral institutions, hospital administration, and patient advocacy groups will benefit from discussions on innovative financing strategies and the role of Private Health Insurance (PHI) in complementing public health systems. The event fosters cross-sector collaboration, providing a platform for evidence-based dialogue and shared learning on sustainable health financing approaches.

    Time and Venue

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

    Registration

    The Regional Knowledge Event is by invitation only. Additional participation can be arranged on request depending on availability. For more enquiries, please contact Ms. Ho Yee MIAO at +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
    Venue: 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) 
    DOWNLOAD

    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)
    DOWNLOAD

    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)
    DOWNLOAD

    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)