Medical insurance offers policyholders peace of mind amidst surging medical fees


The Hong Kong Federation of Insurers (HKFI) today (Thursday, 17 September 2015) announces the medical claims statistics for 2013.

Conducted by HKFI's Medical Insurance Association, the survey collects business data from 18 major underwriters in the medical insurance market, representing over 80% of the market share.

“We are seeing a constant up-trend of medical fees in the past few years due to increasing utilisation and medical progress,” said Mr Terry Tsang, Chairman of HKFI's Medical Insurance Association. “Having said that, the growth of medical insurance premium remains stable at 5% and medical insurance is providing coverage for policyholders and giving them peace of mind.”

The 2013 statistic highlights are as follows:

  • Private group and individual medical insurance plans are providing various forms of protection to close to 4 million people in Hong Kong.

  • 90% of reimbursed claim cases took place in private hospitals or day case clinics. This indicates that the majority of the medical insurance policyholders used private medical services and directly benefited from private insurance coverage.

  • The reimbursement ratio for claims on average dropped slightly from 80% in 2012 to 78% in 2013.  It indicates that policyholders should review their benefit levels regularly to ensure the coverage is sufficient to cover the rising medical fee.

  • Medical cost is inflating.  Based on the historical figures, medical cost inflation (average cost per claim) is in the range of 8 to 10%.

  • Colonoscopy and gastroscopy are the key cost drivers, which represent 40% of the total claim counts and 27.5% of the total claim paid amount of in-patient surgical cases. The number of cases sees a substantial growth by 32% and 20% respectively as compared to previous year.

  • For the fees in conducting colonoscopy and gastroscopy, while the increment of surgeon fees remained stable at 1.3% and 0.8%, the costs for in-patient facilities charged by private hospitals went up by 7.5% and 3.5% respectively (General Ward).

  • For every $100 a patient pays for colonoscopy and gastroscopy at clinic/out-patient facility, he will have to pay $340 / $500 for the same procedures at the General Ward of a hospital.

  • The reimbursement ratio for such procedures at day clinic is more than 90%. That means insurance company will pay more than $90 for every $100 a patient spends (patient paying less than $10). If the same procedure is conducted in in-patient facilities, the insured needs to pay more than $22 out-of-pocket (reimbursement ratio at 78%).

“The 2013 medical insurance statistics reveal one crucial fact - procedures done in clinics and day surgery facilities help contain medical fees and patients will have to pay less,” said Ms Elaine Chan, Deputy Chairman of HKFI’s Task Force on Health Care Reform. “We believe that the Government, medical service providers and insurance industry should make collaborative efforts to educate the public on this front and ensure better usage of resources.”

Medical Claims Statistics Booklet 2013