21st Asia Conference on Healthcare and Health Insurance

Keynote Speech

Policy Leadership Address

Asia's Medical Inflation Crisis Needs a Structural Response: A perspective on the strategic purchasing role in driving healthcare cost containment in the public and private sectors.

Balancing Risk, Regulation and Care: Insights from Australia’s claims experience

Overview: Australia’s claims environment offers a unique vantage point on how insurance, regulation, and healthcare interact under pressure from rising costs, shifting morbidity patterns, and increasing expectations for transparency and consumer protection. This presentation examines the Australian experience to illuminate how risk management, regulatory oversight, and care delivery can be aligned to improve outcomes across the claims lifecycle.

Aligning with insurers: Combating medical inflation through standardized care

Overview: In this session, LIGHTMAC Medical Group will explore strategies to combat medical inflation and optimize loss ratios through the implementation of standardized care models. The discussion will cover key pillars such as ensuring cost predictability, achieving zero administrative friction, and enforcing robust clinical governance to establish trusted provider networks for major insurers.

From claims processing to clinical governance: How independent medical reviews unlock value-based health insurance

Overview: As Asia’s healthcare landscape evolves, insurers face mounting pressure from medical inflation, chronic disease spread and the growing demand for value-based care. This session introduces a new framework for integrating medical specialists and second-opinion networks into insurer workflows which transforms claims management from a transactional process into a strategic platform for clinical governance. By placing physicians at the center of clinical decision making, insurers can become true quality drivers within the healthcare ecosystem, improving outcomes while maintaining cost efficiency. We will demonstrate how utilization reviews reduce unnecessary interventions and how partnerships between insurers, corporates, and providers can promote proactive value-based care. The session will also explore how automation and AI can work side by side with human clinical touch.

The market for traditional chinese medicine (tcm) insurance: Econometric evidence on moral hazard and selection

Abstract: Voluntary health insurance in Hong Kong offers an add-on option to cover Traditional Chinese Medicine (TCM). This option is typically chosen by 34.3% of enrollees with Western Medicine (WM) benefits and 10.7% of the total population. If adverse selection dominates, individuals with higher expected healthcare needs are more likely to choose TCM-inclusive coverage, leading to estimates of utilization biased upwards in naïve models. However, TCM’s holistic appeal could attract people who are more attuned to health and wellness, leading to beneficial selection and lower than average subsequent utilization. We use IV models to detect the direction of the bias. Our instrument set is lags of the insurance coverage of one’s occupational group. Our findings support the beneficial selection hypothesis. IV estimates are two to four times larger than non-IV estimates, indicating that those with a lower propensity to utilize health services self-select into TCM-inclusive coverage. Using instruments to control for bias due to self-selection, TCM-inclusive coverage significantly increases both TCM and WM utilization across extensive and intensive margins, with lower out-of-pocket (OOP) spending, indicating both moral hazard and a complementary relationship between TCM and WM.

Movement towards sustainable medical insurance – what’s the end game?

Contribution of Health Insurance towards Health System Performance