This paper examines the role of consumer activism in the context of contemporary health system reforms. Consumer activism has proved to be a leading force shaping global health governance since the 1960s. Asian consumer activism has played a significant role in governing mixed health systems, for example through quality and price surveillance and advocacy for regulation, as well as campaigns for rational, affordable and quality health provision. At crucial junctures, consumer activism has provided an important counterbalance to private interests seeking to commodify health and healthcare for profit. Malaysia is one of a number of key Asian countries that can be justifiably proud of having developed healthcare systems capable of delivering high quality and relatively accessible care at medium cost. Such strategies have formed the basis for good human development performance and represent significant public investment in human development. However, the increasing cost and complexity of health systems and reforms towards privatization and corporatization pose new challenges for health consumers. This paper examines the specific case of consumer activism in the context of Malaysia’s health system reforms over the past five decades and compares this with trends across the region, and with regard to consumer activism as a global phenomenon. The discussion focuses in particular on the emerging contrasts and tensions between consumer claims for health rights and claims for consumer autonomy and choice.