OBJECTIVES: We identified healthcare financing challenges related to Universal Health Coverage (UHC) and gauged willingness for financing methods to build healthcare-related fiscal space and fund new medical technologies in Indonesia, Malaysia, the Philippines, Singapore, Thailand and Viet Nam.

METHODS: A three-round web-Delphi (Welphi) allowed expert stakeholders from the countries to express agreement/disagreement with a set of 60 policy options, including 35 challenges facing the national health systems and 25 potential financing mechanisms to generate fiscal space and fund medical technologies.

RESULTS: 45 participants from 6 countries completed the Welphi. Across 60 factors assessed, participants reached consensus in 37 instances (70% or more participants chose the same ranking (‘agreed’, ‘disagreed’ or ‘I don’t know’) for each factor). Across all countries, policies to achieve UHC were identified as a government priority. Barriers included increases in non-communicable disease and higher utilization of healthcare alongside institutional rigidity and a lack of prioritization in the healthcare system.

16 mechanisms for increasing fiscal space for healthcare and new technologies were accepted by stakeholders. These tended to centre on increasing efficiencies and included: improving health system digitalization and effective regulation, using international reference pricing to achieve affordable medicines prices and implementing tools for efficient resource allocation based on the clinical and cost effectiveness of a medical technology. Innovative taxes such as sin taxes (earmarked for health) were generally attractive whilst innovative financing mechanisms such as annuity models and impact bonds were only agreed upon by three countries. This suggests more knowledge of these financing mechanisms is needed.

CONCLUSIONS: There is alignment between countries on acceptable mechanisms to increase fiscal space for healthcare and novel medical technologies. However, challenges to effective UHC implementation are varied across ASEAN countries. Countries will require targeted, bespoke recommendations for the adoption of efficient healthcare financing models to facilitate UHC and the funding of novel medical technologies.