A Hong Kong study projecting that private medical insurance claims could double within 10 years if recent growth continues is leading insurers and regulators to re-examine benefit design, utilization patterns, and oversight.
The research, led by Peter Yuen Pok-man, dean of Polytechnic University’s College of Professional and Continuing Education, reviewed more than 10 million medical claims from 2019 and 2023. It found that total reimbursements rose 61% over the four-year period, from HK$10.99 billion (US$3.08 billion) in 2019 to HK$17.73 billion in 2023. “If such an increase continues at the same rate, it will raise serious concerns about the affordability of private health insurance for both employers and individuals, as the costs would be 50% higher in five years and double within 10. Given the pace of the rise, the industry will not be sustainable, and therefore remedial measures must be introduced,” Yuen said, as reported by SCMP.
The study found that most of the increase came from inpatient business. Inpatient reimbursements rose about 75% to more than HK$14 billion, while outpatient payments grew around 24%. Average inpatient claim size increased by roughly 5%, but the number of valid inpatient cases climbed 68%, indicating that claim frequency rather than claim severity has been the main driver. Yuen said room and board costs increased about 24%, which he viewed as consistent with greater use of day procedures rather than longer inpatient stays. On the outpatient side, general practitioner visits declined slightly, while claims for Chinese medicine, physiotherapy, and chiropractic services – typically at higher fee levels – increased.
The analysis pointed to shifts in case mix. In 2023, digestive system diseases were the most common inpatient condition by claim count, with 20,966 cases, followed by viral warts with 14,347. A large share of digestive system claims was linked to gastro-colonoscopy procedures. Yuen said many colonoscopy cases were elective and that some policyholders at relatively low clinical risk opted for procedures because they were covered under their policies.
Yuen suggested that insurers and policymakers consider adjustments to reimbursement terms for selected procedures to moderate growth in non-urgent utilization. “While setting a lower reimbursement limit and introducing co-payment mechanisms for these procedures could mitigate the situation, the trend would be difficult to reverse given Hong Kong’s ageing population. Different stakeholders should sit down and discuss in-depth how to suppress the growth,” he said. Hong Kong’s demographic profile is expected to reinforce these pressures. People aged 65 and above accounted for about 22% of the city’s 7.5 million residents in 2023, and that share is projected to reach 36% by 2047. Longer lifespans and more frequent use of preventive and diagnostic interventions are likely to affect medical claim volumes and costs for both group and individual products.
The study’s findings come as Hong Kong’s Insurance Authority (IA) conducts a market-wide review of medical insurance pricing and benefits. The initiative is meant to respond to ongoing healthcare cost inflation and to reassess how medical insurance operates for both local and international policyholders. “We would like to see the insurance companies introduce more medical insurance products that are more accessible and affordable for the general public, with sales practices that are fair to consumers,” said Clement Lau Chung-kin, the IA’s executive director of policy and legislation, as reported by SCMP.
During the year, the IA plans to collect detailed data from medical insurers, including premium rates, claims experience, and distribution compensation structures. The regulator aims to build an anonymized, market-wide dataset that can be shared in a way that allows individuals and employers to compare products, benefits and pricing more systematically. Insurance Authority CEO Clement Cheung Wan-ching said the initiative is intended to give market participants and customers more information.
“Industry-wide comprehensive data would also be useful to help insurance companies introduce more medical insurance products to customers, increasing competition in the industry and hopefully bringing prices down. We also want to make it easier for policyholders to change providers, which would also bring in better benefits and more choice for customers,” Cheung said. The IA has also indicated interest in how insurers structure and sell medical products in the retail channel, which could lead to changes in distribution practices.
Hong Kong’s experience sits within broader cost and demographic trends. Cheung has said that overall medical expenses in the city have been rising at about 9% per year in recent years, with some high-end medical coverage segments seeing annual increases approaching 30%. Data from the Hong Kong Employee Health Insurance Index indicates that the average annual premium per insured person is expected to reach HK$11,078 in 2026, nearly 15% higher than in the second quarter of 2025.
These developments align with regional and global patterns identified in WTW’s 2026 Global Medical Trends Survey. The study projects a global medical trend of 10.3% in 2026, up from an estimated 10.0% in 2025. Asia-Pacific is forecast to record the highest regional medical trend at 14.0% in 2026, compared with 13.2% in 2025, ahead of Latin America, the Middle East and Africa, North America, and Europe.
