Hong Kong doctors slam insurer’s decision to limit benefits for hospital procedures as ‘unacceptable’ and unsafe

AIA says it is considering removing coverage for ‘simple’ operations such as colonoscopy, gastroscopy and cataract surgery

PUBLISHED : Tuesday, 21 February, 2017, 1:32pm
UPDATED : Tuesday, 21 February, 2017, 1:49pm

The head of the Hong Kong Medical Association has criticised leading insurance firm AIA for tightening its claims policy for a number of hospital procedures, saying it threatens patient safety.

The insurer last month advised doctors that it is considering scrapping all benefits covering hospitalisation fees for “simple procedures”, such as colonoscopy, gastroscopy and cataract surgery, or hospital stays that are not deemed “medically necessary”.

Such a change would mean patients would instead have to receive such procedures in the city’s day medical clinics in order to be covered by insurance.

Hong Kong health insurance giant tightens reimbursement policy

Dr Gabriel Choi Kin, president of the Medical Association, criticised AIA’s move as “unacceptable”, and said carrying out such procedures in day medical clinics was not entirely safe.

“Observations by nurses would be less if patients were forced to leave right after the surgery,” Choi. said.

“It’s up to [doctors] to decide whether a patient requires [a hospital stay]. Whether the stay would be reimbursed is purely up to the insurance company,” he added.

He cited a complaint received by Hong Kong’s Medical Council in which a patient’s intestine had broken after receiving a colonoscopy at a day medical clinic. Such a condition could require hospital care, Choi added.

“I am a client and I hope to go to a safer and more comfortable environment,” he said.

“Why am I forced to receive the procedures in a medical day care centre?” he said.

In a statement published Tuesday, AIA said it respected doctors’ professional and reasonable judgment with regards to what is deemed “medically necessary”. But it hoped to work with doctors to control inflation in medical costs and maintain a reasonable level of claims.

Elaine Chan Sau-ho, deputy chairwoman of the Federation of Insurers’ task force on health care reform, explained that AIA’s arrangement sought to flesh out unreasonable overcharging in the city’s hospitals.

In a statement, AIA cited examples of overcharging, including one of a HK$400,000 gallbladder removal surgery – far above the average claim cost of between HK$50,000 and HK$80,000.

She ensured that hospital stays for high-risk patients, such as those with heart disease, would still be covered.

Insurance sector lawmaker Chan Kin-por said AIA’s decision to tighten claims for simple procedures was meant as a reminder to doctors, and a way to curb inappropriate insurance claims.