The Hong Kong Federation of Insurers (HKFI) today (Thursday, 21 July 2016) announces the medical claims statistics for 2014.

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 utilization and medical progress,” said Ms Zenda Chan, Chairman of HKFI's Medical Insurance Association.  “Having said that, the average growth of individual and group medical insurance premium over the past 5 years remains stable in a range of 4 to 5.2% and medical insurance is providing coverage for policyholders and giving them peace of mind.”

The 2014 statistic highlights are as follows:

• Private group and individual medical insurance plans are providing various forms of protection to more than 4 million people in Hong Kong.  The number of insured members has increased more than 200,000 in a single year.

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

• The average reimbursement ratio slightly dropped.  Policyholders should regularly review their benefit coverage to ensure their coverage is sufficient to cover the rising medical expenses.

• Medical cost inflation remained significant.  Comparing with 2013, the average claim cost for in-patient treatment increased by about 6% to 7% whereas that for day case surgeries increased by 18%.

• Colonoscopy and gastroscopy were still the key cost drivers, representing 49% of the total claim counts and 37% of the total paid amount of in-patient surgeries. 

• Colonoscopy and gastroscopy charged in the General Ward experienced average surgeon fee increase of 5% and 8% respectively, while the average charges for in-patient facilities went up by 11% and 8% respectively.

• Study reviews that a patient should expect medical expenses to triple or quadruple for colonoscopy and gastroscopy performed in the General Ward instead of in an outpatient setting.

• The reimbursement ratio for colonoscopy at day clinic was 91%.  That means insurance company will pay $91 for every $100 a patient spends (patient paying $9). For the same procedure conducted in a hospital, the insured pays $16 out-of-pocket (reimbursement ratio at 84%).

• Study of the two procedures reveals significant variation of surgeon’s fee and facility charges. The top 2% claims were often 3-4 times of the average cost. Patients are advised to get a quotation from their doctors and the insurers to pre-assess against their coverage to avoid unexpected out-of-pocket expenses.

“The 2014 medical insurance statistics reveal one crucial fact - procedures done in clinics and day surgery facilities help contain medical fees and patients will 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 educate the public on this front and ensure better usage of resources.”

Medical Claims Statistics Booklet 2014