Asia Pacific’s ageing economies are entering a more demanding phase of healthcare planning. As populations live longer, the challenge for healthcare systems is no longer only about extending life expectancy. It is also about reducing the number of years people spend in poor health.

This is the question we address in The Value of Chronic Care, our latest report which examines chronic disease burden and health system performance across 38 countries in the Organisation for Economic Co-operation and Development (OECD), covering more than 200 chronic conditions over 10 years of data. The report introduces a Chronic Care Index, which ranks how well countries are positioned to manage chronic disease by looking at two areas: the scale of chronic disease burden, measured through years of healthy life lost, and health system performance, including capacity, quality and readiness. Higher scores indicate stronger performance.

The APAC economies included in the index are Australia, Japan, New Zealand and South Korea. Among them, South Korea ranks fifth overall on the Chronic Care Index, placing it among the stronger-performing countries despite being a super-aged society. Australia also ranks among the top 10, at eighth overall, while Japan ranks second on health system performance, but lower on chronic disease burden, showing how even capable systems can come under pressure when populations age and long-term illness accumulates.

Across the index, the findings point to a wider shift in chronic disease: fewer people are dying prematurely from some major conditions, but more are living longer with illness and disability. This changes chronic care from a short-term health event into a long-duration risk, with outcomes shaped by how effectively care is organised, accessed and sustained over time.

Prevention needs to start earlier

Prevention is often discussed in simple terms: healthier diets, more exercise and regular screening. These remain important, but chronic disease risk is shaped by a wider set of factors. Lifestyle, work, income, environment, family history and access to care all influence how risk builds over time.

Importantly, prevention has to start earlier. In many countries, chronic disease burden is shifting from mortality to morbidity: fewer people are dying prematurely from some major conditions, but more are living longer with illness and disability.

This reflects progress, but it also changes the profile of chronic care. Neoplasms and cardiovascular disease together account for 43% of total healthy life lost across OECD countries and remain heavily mortality-led. At the same time, conditions characterised by long-term management, including mental health and neurological diseases, have increased in morbidity impact and now account for 10% and 9% of total healthy life lost respectively.

This shifts the challenge from short-term health events to long-duration risk. Health systems still need strong treatment capacity, but they also need to support people through years of condition management, functional decline, relapse risk and multimorbidity. 

Metabolic risk is becoming increasingly important in this shift. In some stronger-performing countries, behavioural risks have declined, but risks linked to obesity, blood pressure and blood glucose are moving in the opposite direction. As societies age, prevention will need to combine population-level risk reduction with earlier identification, monitoring and long-term management.

Regional reforms show how primary care can support earlier intervention

A recurring finding from the report is that resources alone do not guarantee outcomes. Across the index, capacity scores vary less than quality and readiness scores, making care quality, access, coordination and continuity more important differentiators between countries.

While Singapore and Hong Kong are not part of the OECD-based index, their primary healthcare reforms show how ageing markets in APAC are responding to similar pressures. Prevention depends not only on screening programmes or public health campaigns, but on whether people have a consistent route into care and regular follow-up over time. This is where primary care becomes important: It gives individuals a first point of contact for risk assessment, early diagnosis and ongoing condition management.

Take Singapore, for example. Its citizen population is ageing quickly, with close to one in four citizens expected to be aged 65 and above by 2030. While Singapore continues to benefit from a relatively healthy population base, chronic disease risk remains a concern. Recent national health data shows that around one in three Singapore residents has hyperlipidaemia and/or hypertension, while obesity has also increased in recent years.

Its Healthier SG initiative responds to this by strengthening the relationship between residents and primary care providers. The initiative encourages residents to enrol with a family doctor and develop a personalised health plan, supporting earlier screening, regular follow-up and more consistent lifestyle advice before conditions worsen or require hospital care.

Hong Kong is moving in a similar direction through primary healthcare reform. Its Primary Healthcare Blueprint projects that people aged 65 and over will rise from 20% of the population in 2021 to 31% in 2039. Against this backdrop, its Chronic Disease Co-Care Pilot Scheme supports screening and management for diabetes and hypertension among eligible residents aged 45 and above, with the aim of encouraging earlier prevention, identification and treatment.

South Korea shows the value of active risk management

Meanwhile, South Korea shows why prevention needs to keep evolving, even in stronger-performing systems.

The country is now a super-aged society, with more than 20% of its population aged 65 and above. Even so, it performs strongly on chronic disease burden, ranking fourth among the 38 countries assessed, rising to first when adjusted for age.

This matters because it shows that ageing pressure can be managed more effectively when countries take a sustained approach to prevention and risk management.

South Korea’s approach combines long-term policy planning, public health surveillance and targeted intervention. Its National Health Plan 2030 sets out a multi-sector framework covering smoking, alcohol, nutrition, physical activity, cardiovascular disease and obesity, with the aim of extending healthy life expectancy.

The country has also taken action on major behavioural risks, particularly tobacco and alcohol, through tighter controls, cessation support and public health campaigns, reducing their impact as risk factors over the past decade.

At the same time, however, metabolic risks are moving in the opposite direction. Our analysis notes that high fasting plasma glucose and high body-mass index have seen some of the largest increases in contribution to disease burden in South Korea, shifting the challenge towards earlier detection and long-term condition management.

This is where data and surveillance become important. South Korea uses large-scale national health surveys to track changes in diet, activity and metabolic health. These insights help policymakers identify emerging risks earlier and adjust interventions accordingly.

The country has also developed chronic disease management programmes for conditions such as hypertension and diabetes. These combine education, counselling, nutrition and exercise support, alongside reminder systems that encourage follow-up and continuity of care.

The lesson for the region is practical: Healthy ageing requires consistent risk management over time, combining prevention, regulation, and sustained disease management as the nature of that risk evolves.

Digital health and community care can help ease system pressure

As chronic disease becomes a longer-term management challenge, health systems will need to support patients across more settings, not just in hospitals or specialist care. Our report highlights the importance of more integrated care journeys, with better connection between primary care, specialists, community providers, employers, insurers and caregivers.

Japan shows why this is so important. The country ranks second on health system performance index, reflecting the strength of its healthcare system. However, its ageing profile continues to place sustained pressure on care delivery. As of October 2024, people aged 65 and over numbered 36 million, or 29.3% of Japan’s population. Those aged 75 and over also already outnumber the 65–74 age group, underscoring that the challenge is not only population ageing, but more advanced ageing and higher care intensity.

Australia points to a related challenge. It ranks eighth overall on the Chronic Care Index, combining relatively low mortality with strong system performance. However, as morbidity rises, the report notes that outcomes will increasingly depend on how well systems sustain care over time, including through integrated, multidisciplinary models focused on multimorbidity, function and independence.

Digital health can help support this shift. Risk assessment, remote monitoring, medication reminders and follow-up tools can help patients stay connected to care teams, while giving providers earlier visibility when conditions deteriorate.

Community-based care will also become more important as care needs grow more complex. Dementia illustrates this clearly: as the condition progresses, care often shifts from clinical treatment to sustained support with daily living, with families taking on much of the coordination and caregiving burden. Support such as caregiver education, case management, home-based services and community programmes can help people remain independent for longer while reducing pressure on formal care settings.

Rethinking chronic care before pressure peaks

Ageing APAC economies still have an opportunity to act before demographic pressure becomes harder to manage. The findings point to a clear shift in priorities: prevention needs to start earlier, care journeys need to become more integrated, and responsibility needs to be shared across public health systems, employers, insurers and communities.

For healthcare systems, the priority is to move earlier and stay connected for longer. It also has implications for companies developing therapies, diagnostics, digital tools and care solutions – as chronic disease becomes a longer-term management challenge, value will increasingly depend on how well these innovations support earlier identification, sustained adherence, remote monitoring and measurable outcomes over time.

The next phase of chronic care will require stronger collaboration across the healthcare ecosystem. As countries look to close the gap between longer lives and healthier lives, there is an opportunity to build solutions that support patients across the full journey of prevention, diagnosis and long-term disease management.