Discussions on commercial determinants of health have focused largely on industries producing harmful commodities, while the role of commercial forces within health service delivery and financing has received less attention. Yet private hospitals and health insurers are among the most influential commercial actors in contemporary health systems globally. Their business models, pricing strategies, investment structures, and contractual arrangements directly shape which populations are served, what services are prioritised, and how financial risks are distributed.

Health economics provides a rigorous analytical framework to examine these dynamics. Core concepts such as market failure-monopoly power, externalities, public goods, and information asymmetries–help explain persistent problems including adverse selection, moral hazard, supplier-induced demand, and principal–agent tensions between patients, providers, insurers, and governments. These forces influence clinical decision-making, provider behaviour, and insurance design, with direct implications for efficiency, equity, and financial protection.

Meanwhile, cost-effectiveness analysis and health technology assessment (HTA) are increasingly used by governments to mediate the interface between commercial interests and public financing decisions. Recent debates over cost-effectiveness thresholds–such as the United Kingdom’s National Institute for Health and Care Excellence (NICE) threshold adjustment in the context of international trade negotiations-highlight how global economic and political pressures can reshape national decision rules, with downstream consequences for access to medicines and health technologies.

This session applies a health economics lens to two interrelated sectors: (i) private healthcare delivery, including public-private partnership (PPP) hospitals and private providers serving publicly financed patients; and (ii) private health insurance operating alongside government schemes, social health insurance, and out-of-pocket payments. Drawing on experiences across different income and institutional contexts, the session explores how market incentives function as commercial determinants of population health, which will inform how they can be restructured to support universal health coverage (UHC); and potentially inform regional or inter-governmental initiatives to overcome challenges to access health technologies. With the growing emphasis on mobilising private capital for health in the context of rising health expenditure, medical inflation, and fiscal pressure, understanding the mechanisms through which market incentives interact with health system architecture–and the conditions under which they support or erode coverage, equity, and financial protection–has become more important than ever.