In the World Health Report 2000, the World Health Organization (WHO) asserts that a large part of the variation in the health statuses of countries can be attributed to differences in health system performance. In particular, differences in health system performance explain the marked variation even amongst countries with similar incomes and expenditures. Asia spans two WHO regions of South-East Asia and the Western Pacifi c, and accounts for 60 per cent of the world’s population. It encompasses more than 20 nations. Some have health systems that rank amongst the world’s best, and yet others have diffi culty providing the basics of safe drinking water and modern sanitation. With populations ageing at an ever-increasing rate, non-communicable diseases (NCDs) have, or will soon, overtake communicable diseases as the main cause of disability and premature mortality. Neuropsychiatric disorders, cardiovascular diseases and malignant neoplasms are responsible for the bulk of the burden of the NCDs. The burden of communicable diseases also remains signifi cant. Many of the less developed countries operate in a ‘worst-case scenario’, facing a double burden of communicable and non-communicable diseases, with threats of new emerging infectious diseases. Poverty is a major cause of health inequalities in Asia, along with often poverty-related factors such as access to basic health care and education. Given such conditions, what should be the role of health systems towards the improvement of public health in Asia? Comparisons of health systems in the many diverse countries of Asia are challenging, since they are currently classifi ed under different regional groupings for political and economic cooperation, including health matters which are divided under the WHO South-East Asia and Western Pacifi c Regional Offi ces (see Table 46.1 ). This chapter will examine the main determinants and common criteria for comparing health systems performance to achieve better public health.