Health systems are under pressure in Asia. Epidemiological and demographic transitions are taking place much faster than in Europe and America, in the span of a single generation. With the transition comes the non-communicable disease (NCD) epidemic that requires more sophisticated and expensive interventions provided by hospitals, inpatient or outpatient. Rapid economic development in Asia has lifted millions out of poverty and raised peoples’ expectations for services. Between China, India, Thailand, Philippines, Indonesia and Vietnam, expansion of health insurance coverage during the last decade has reached an additional one billion people, making services more affordable and thus increasing demand. Advancing medical technology eagerly awaited by specialist doctors sitting on top of health professional hierarchies further expands possibilities for treatment. The middle class votes with their feet and takes their health problems to medical tourism meccas like those in Bangkok and Singapore, voiding their own countries of additional income to health care providers. Policymakers are scrambling to expand hospital capacity, boost the pay of health professionals, and encourage investment to meet the demand.
But governments do not wait. They are exploring hospital autonomy, decentralization, user fees and private sector participation. These policies often pose risks that need to be mitigated by policies and institutional arrangements. For example, health care providers sometimes order unnecessary procedures to earn additional revenue, thanks to the powerful incentive of the fee-for-service payment mechanism and information asymmetry between the patient and health care provider. This can mean financial ruin for both the patient and new, relatively weak health insurance agencies.
Despite these challenges, hospitals aren’t high on the international health development agenda, save a few initiatives to improve quality and provider payment reform.