By any standard, Hong Kong, Malaysia and Singapore are remarkable health care performers. In this article we document their performance – which in each case combines excellent outcomes with low cost – and argue that across all three cases it has a lot to do with the British colonial legacy. In particular, this legacy has generated a strong state role in health care provision. On the basis of these three experiences, we hold that health care reformers should shift their attention from finance, which continues to be something of an obsession for many contributors to debate, and look more closely at provision.