Replies to LegCo questions
LCQ7: Medical insurance
Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (November 9):
Question:
It has been reported that there were cases in which existing local medical
insurance providers were selective in accepting applications for insurance
covers; and there are also complaints against insurance companies which set
discriminatory terms and conditions in their medical insurance policies, and
refuse to provide insurance covers for psychiatric patients and the chronically
ill. In this connection, will the Government inform this Council:
(a) of the number of insurance companies in Hong Kong which specialise in
medical insurance and critical illness insurance at present, the coverage of the
insurance policies concerned and the illnesses and medical services which fall
outside such coverage; and the number of such companies which offer
comprehensive medical insurance and accept applications for covers for all types
of illnesses without setting any restrictive terms;
(b) of the statistics on the risk assessment of medical insurance, including the
number of psychiatric patients and the chronically ill admitted by public
hospitals over the past three years, the average health care cost and amount of
public funding involved, and the estimated expenses that might have incurred if
such patients had received treatments in private hospitals; and
(c) whether it will consider reviewing and enhancing the regulation of medical
insurance coverage in order to recommend insurance scheme choices to the public
more specifically when proposing practicable options for financing health care
in future, so that the public may enjoy medical protection?
Reply:
Madam President,
(a) "Medical insurance" and "critical illness insurance" are two different types
of insurance. The former generally refers to insurance that provides medical
cost coverage to an insured in the event of his illness while with the latter,
an insured will be offered a fixed sum of compensation when confirmed to have
contracted any specified serious illness. In Hong Kong, medical insurance is
normally sold by insurers carrying on general insurance business under a
stand-alone policy, or offered by insurers carrying on long term business (i.e.
life insurance) in the form of a rider to a life insurance policy. Most of the
critical illness insurances are sold by way of adding a rider as mentioned above
by insurers carrying on long term business. Such products, however, are also
sold by some of the insurers carrying on general insurance business.
There are currently a total of 96 insurers (namely 29 long-term business
insurers, 53 general business insurers and 14 composite insurers) authorised to
provide critical illness insurances or medical insurances.
Coverage of medical insurance is determined by the terms and conditions of
individual insurance policies. Generally, it may cover fees for hospitalization,
surgeons, anaesthetists and operation rooms, etc. For critical illness
insurance, it normally restricts cover to about 30 to 40 types of serious
illness, including fatal illnesses such as cancer, heart attack (myocardial
infarction) and end stage renal failure.
At present, medical and critical illness insurances will generally contain a
number of restrictive terms or exclusions. Common exclusions include
pre-existing medical condition, congenital diseases, AIDS and engaging in
dangerous activities. Whether insurers will accept applications for insurance
from people with a specific illness would depend on individual insurers'
underwriting policy in respect of the relevant risks.
(b) The number of psychiatric patients admitted by public hospitals, the average
cost of medical services provided to them, and the relevant total yearly
expenditure by the Hospital Authority (HA) in the past three years are set out
in the table.
HA does not routinely collate statistics on the number of its chronic patients
or related expenditure. Based on available data on the top 15 disease groups by
principal diagnoses, it is estimated that around 200,000 chronic patients are
admitted to hospitals for treatment each year. However, due to the great variety
of clinical conditions and their varying complexity that may be involved in
these admissions, it is not possible to estimate accurately the amount of
expenditure by the HA on treating these patients or the amount of expenses that
may be incurred if they were treated in private hospitals.
(c) The Health and Medical Development Advisory Committee (the Committee)
published a discussion paper entitled "Building a Healthy Tomorrow" in July this
year to discuss the future service delivery model for our health care system.
Public consultation on the Paper just ended on October 31 and we are now
collating the views collected. The Committee will proceed to the next stage and
study the issue of health care financing. The role to be played by medical
insurance in financing options and the availability of other supporting
arrangements, etc. will be considered by the Committee.
At present, the Commissioner of Insurance does not have the statutory power to
regulate the terms or premium of insurance products (including medical insurance
products). That said, if the Committee considers that the feasibility of medical
insurance as a future financing option merits further study, we will certainly
discuss with the relevant sectors how medical insurance can be built into the
whole financing package.
Ends/Wednesday, November 9, 2005
Issued at HKT 12:41
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Table to LCQ7