Doubts on cover for high-risk patients

PUBLISHED : Tuesday, 05 June, 2012, 12:00am
UPDATED : Tuesday, 05 June, 2012, 12:00am


About 10 per cent of people who join the government's planned health insurance scheme will be ranked as high-risk, actuarial calculations show, leading lawmakers to cast doubt on the financial viability of the scheme.

High-risk members, those with an existing illness or a family history of serious illness, will pay premiums three times as high as other patients, but their medical expenses are six times as high as those patients considered to have a normal risk.

The scheme is being created to rebalance a healthcare system in which the public sector takes 90 per cent of patients while 60 per cent of doctors work in the private sector.

Premiums for those at high risk will be kept in a separate pool and topped up from the HK$50 billion government funding allocated to the scheme, but lawmakers fear the money will run out.

The Food and Health Bureau said in a report to the Legislative Council subcommittee examining the scheme that the financial condition of the high-risk pool would depend very much on how many people enrol and the outcome of claims from high-risk individuals.

'Does it mean that it will burst? Like when many high-risk people come and many claim compensation?' committee chairman and medical sector lawmaker Dr Leung Ka-lau said at the meeting yesterday.

Lawmakers Li Fung-ying and Cyd Ho Sau-lan raised another concern - that the cost of insurance would be too high for high-risk patients, which would leave only a small pool of cash to pay for treatment.

Permanent Secretary for Food and Health Richard Yuen Ming-fai said the number of high-risk people likely to join the scheme had been calculated using actuarial science.

Consultants for the government expect many people covered by private medical insurance to switch to the scheme in the first year, including many high-risk individuals. The proportion of people signing up to the scheme who are in the high-risk category is expected to fall to 2 per cent over time, the consultants say.


Proportion of those likely to be ranked high-risk under health insurance scheme. They face premiums three times higher than normal