The newly industrialised and high income economies of East Asia perform remarkably well on a range of health system indicators. We adopt an institutional lens to examine and compare the similarities and differences in health care financing and provision in the paired cases of Singapore, Malaysia, Taiwan and South Korea. This illuminates how, despite seemingly common global, regional and functional demands, reformers have responded through diverse means to different institutional constraints. Moreover, some of these cases illuminate the cognisance of reformers with respect to vulnerabilities in their own health care systems enabling effective, albeit ongoing, management.