The health disparities that divide indigenous peoples from the non-indigenous ‘mainstream’ populations of Malaysia and Australia have provoked much social and academic concern. Existing studies focus predominantly on the epidemiological aspects of indigenous health. Given the political and historical nature of indigenous healthcare, however, there is a need to shift the analytical focus from the objects of policy (indigenous peoples) to the makers of policy (the state and bureaucrats). This talk aims to explicate some of the factors that led to the adoption of similar (and different) policy approaches to healthcare for the Orang Asli of Malaysia and Aboriginal Australians. Through an analysis of primary sources (which includes the unpublished diaries of Dr John Bolton) and secondary literature, I will demonstrate comparatively the application of state-centred theories in explaining the historical development of indigenous healthcare policies in Malaysia and Australia. The three state-centred factors that have influenced the adoption of these policies are first, the need to maintain domestic order-keeping functions; second, the independent bureaucratic shaping of policies; and third, the structure of the state in determining the organisational possibilities of the state. By conducting a cross-national comparison of indigenous healthcare systems, the talk sets out to reflect critically on the historical and bureaucratic nature of public policies more broadly as well as to inform healthcare policymaking for indigenous peoples.