(Hong Kong, 28 April 2026) – The Hong Kong Federation of Insurers (HKFI) today announced the findings of the "Determinants of Post-Pandemic Medical Inflation: An Analysis of Private Insurance Claims Data in Hong Kong" study, commissioned by the HKFI and conducted by the Centre for Ageing and Healthcare Management Research of the College of Professional and Continuing Education (PolyU CPCE) at The Hong Kong Polytechnic University (PolyU).

The study, based on data from Hong Kong's private medical insurance market, found a staggering increase of over 60% in overall medical expenditure from 2019 to 2023, representing a double-digit compound annual growth rate. The core driver of this increase was not the unit price of medical services, but a sharp rise of nearly 70% in the claim frequency for inpatient plans, which is directly linked to a surge in day procedures.

This research analysed over ten million inpatient and outpatient claim records, comprehensively comparing the claim frequency, average bill amount per claim, and total medical expenditure before and after the pandemic (2019 vs. 2023). It provides an in-depth analysis of structural changes across demographics, policy types, and medical networks. The findings reflect a worrying upward trend in medical expenditure and premiums in Hong Kong's private medical insurance market. If effective measures are not taken promptly, the long-term affordability and sustainability of the market will face severe challenges.

Surge in Inpatient Claim Frequency Driven by Day Procedures

The study indicates that medical claim expenses in the private market have risen sharply post-pandemic, recording double-digit growth for several consecutive years. If this trend continues, it will severely impact the affordability of premiums for employers and individuals, exert operational pressure on insurance companies, and indirectly strain the public healthcare system.

In contrast, the average bill amount per inpatient claim saw only a modest increase, indicating that the overall expenditure growth was driven by claim frequency, especially for day procedures, rather than by a sharp rise in unit prices.

• Overall Inpatient Claim Frequency: Increased sharply by 68% in four years.

• Small to Medium Claims (approx. HK$5,000 to HK$15,000): Number of cases grew by about 80%.

• Large Claims (over HK$100,000): Number of cases more than doubled.

• Room and Board Claims: The number of claims grew by less than 30%, a stark contrast to the overall inpatient frequency surge, further confirming that the growth primarily came from day procedures rather than traditional hospital stays.

In 2023, the conditions with the highest inpatient claim frequencies were digestive system diseases (e.g. gastritis and duodenitis), viral warts, and viral diseases. Gastro-colonoscopy procedures accounted for a significant portion of claims for digestive system diseases. This suggests the trend is susceptible to consumer and/or provider behaviour. The study also found a substantial increase in the claim frequency for diagnostic tests.

Shift in Outpatient Service Consumption Towards Higher-Cost Services

Although the overall claim frequency for outpatient plans slightly decreased due to a drop in general practitioner (GP) visits, the data shows a clear consumer shift towards higher-cost specialist and therapeutic services.

• General Practitioners: Number of visits decreased by nearly 20%, with an average claim amount of less than HK$400 per visit.

• Chinese Medicine Practitioners: Number of claims grew by about 40%.

• Physiotherapists: Number of claims grew by about 40%.

• Chiropractors: Number of claims grew by nearly 70%.

• High-End Service Fees: The average claim amounts for specialists, chiropractors, and physiotherapists (ranging from HK$600 to over HK$900) were much higher than for GPs.

The study further notes that against the backdrop of an aging population and a rising prevalence of chronic diseases, more people are suffering from conditions that can be effectively managed by physiotherapists and Chinese medicine practitioners, a trend that is unlikely to be reversed.

Policy Design Has Significant Impact: Group Plans and Panel Doctors Effectively Control Costs

The research also compared claim differences across policy types, revealing that group plans and panel doctors are effective in controlling expenses.

• Group vs. Individual Plans: The average inpatient claim amount for group plans was about 40% lower than for individual plans; for outpatient services, it was about 50% lower.

• Panel vs. Non-Panel Doctors: The average inpatient claim amount for using panel providers was over 40% lower than for non-panel providers.

• Voluntary Health Insurance Scheme (VHIS): The average inpatient claim amount was slightly lower than that of non-VHIS individual plans, with a difference of about 10%.

These results remained consistent even after controlling for age differences, suggesting that promoting the use of medical networks and having individual plans adopt certain features of group plans could help control rising medical costs.

Aging Population Exacerbates Expenditure Pressure

The study also found that medical expenses increase significantly with age, and this pressure will intensify as Hong Kong's population continues to age.

• Ageing: Expenses rise sharply with age, with the 75+ age group incurring the highest average bill amount.

• Gender: While females claimed more frequently, males had a higher average inpatient cost.

Prof. Peter Yuen, Dean of PolyU CPCE, stated, "This study clearly indicates that overall health insurance claims increased very substantially after the pandemic. The overall increase amounted to a double-digit increase every year. Such an increase, if it continues at the same rate, will raise serious questions about private health insurance affordability for employers and individuals. Furthermore, among the conditions with the highest claim frequency, we noted a particularly significant increase in cases related to gastro-colonoscopy for digestive system diseases and treatments for viral warts. This growth trend seems to be driven not just by natural changes in the population's health status, but more likely by a shift in citizen behaviour, such as an increased willingness to undergo preventive screenings or elective treatments. This phenomenon warrants in-depth discussion as it pertains to the future use of medical resources."

Ms Selina Lau, Chief Executive of the HKFI, said, "We are grateful to Prof. Yuen and his team for their professional and independent research. The results reveal that the continuous surge in Hong Kong's medical expenses, which leads to higher medical insurance costs, is no longer an issue for the insurance industry alone but a heavy price for society as a whole to pay. We will discuss with the authorities and relevant stakeholders how to address this issue that affects the long-term well-being of Hong Kong. We also call on the public to use their medical insurance prudently, especially in a rapidly aging population, to ensure that medical insurance can truly serve patients in need."

Rising Medical Expenditure Pressure Calls for Multi-Party Collaboration

The study's findings suggest a rather alarming trajectory for healthcare expenditure and related premiums in the private sector. It is imperative that individuals, employers, insurers, healthcare providers, and the Government work together to chart a path forward, ensuring the long-term affordability and sustainability of Hong Kong's private health insurance market.

For details, please refer to the Executive Summary of Research Report and the Presentation Deck.