Private medical expenditure funded by Hong Kong’s private health insurance market rose by more than 60% from 2019 to 2023, driven mainly by a sharp increase in how often policyholders claim rather than a surge in unit prices, a study commissioned by the Hong Kong Federation of Insurers (HKFI) has found.
HKFI said the research, conducted by PolyU CPCE’s Centre for Ageing and Healthcare Management Research, analysed more than 10 million inpatient and outpatient claim records and compared patterns before and after the pandemic (2019 versus 2023).
The study found that inpatient claim frequency climbed 68% over the four-year period, with day procedures identified as the key driver. Small-to-medium claims of about HK$5,000 (US$637.98) to HK$15,000 rose around 80%, while the number of large claims above HK$100,000 more than doubled. Room-and-board claims increased by less than 30%, supporting the view that growth came from short-stay and same-day treatments rather than traditional hospitalisation.
Digestive system diseases, viral warts, and viral diseases recorded the highest inpatient claim frequencies in 2023, with gastro-colonoscopy procedures making up a significant share of digestive-system claims, while diagnostic testing also rose, the report said.
Outpatient claim frequency dipped slightly as general practitioner visits fell by nearly 20%, but the data pointed to a shift towards higher-cost services, with claims for Chinese medicine practitioners and physiotherapists up about 40% and chiropractors up nearly 70%. Average claim amounts for specialists, chiropractors and physiotherapists were reported at HK$600 to more than HK$900, versus less than HK$400 for GP visits.
The report also found that policy design mattered: average inpatient claims were about 40% lower for group plans than for individual plans, and more than 40% lower when using panel doctors compared with non-panel providers, while Voluntary Health Insurance Scheme inpatient claims were around 10% lower than those for non-VHIS individual plans.
Prof. Peter Yuen, dean of PolyU CPCE, said the trend “will raise serious questions about private health insurance affordability”, while HKFI chief executive Selina Lau said surging medical costs were “no longer an issue for the insurance industry alone but a heavy price for society as a whole to pay.”
