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Hong Kong's insurance regulator warned on Thursday that the government cannot keep carrying the city's medical bill while only about half of residents have coverage. The government's own health accounts show who already pays much of the rest. In 2024/25, households paid HK$82.4 billion out of pocket. That is almost twice the HK$44 billion paid by every employer and individual insurance scheme combined.

Insurance Authority chief executive Clement Cheung Wan-ching said insurance accounted for about 16% of local medical spending and the government for 51%. He was speaking at the International Association of Insurance Supervisors' annual conference. He said medical inflation was running at 10% a year and only 20% of residents aged 65 and over held coverage, so the burden on government was unsustainable, The Standard reported.

The coverage split matches the government's last count. A Census and Statistics Department survey run from December 2022 to April 2023 found 49.7% of residents were covered by employer medical benefits, individually bought insurance, or both.

Cheung's two shares add up to two-thirds. The Health Bureau's Domestic Health Accounts, released in August, account for the rest. Current health expenditure was HK$262.5 billion in 2024/25. Government schemes paid 51.4% and insurance 16.8%, split between employer plans and policies people bought themselves. Households paid 31.4% directly.

That is roughly HK$10,950 for every resident.

At Cheung's 10%, that figure would reach about HK$17,600 a head in five years, or HK$6,700 more a year than now. Over those five years a resident would pay about HK$73,500, against HK$54,800 if costs stood still.

So far the bureau's data show household spending rising more slowly than that. Out-of-pocket payments grew 5.7% in 2024/25 and about 6.5% a year since 2021/22. At that pace the per-resident bill would be close to HK$15,000 by 2029/30. Even the slower path adds roughly HK$4,000 a head.

The steeper curve shows up in insurers' books. Peter Yuen Pok-man, dean of Polytechnic University's College of Professional and Continuing Education, led a study of more than 10 million claims. It found reimbursements rose 61% between 2019 and 2023, to HK$17.73 billion. Most of the rise came from more inpatient cases rather than costlier ones. Valid cases climbed 68% while the average claim grew about 5%. Yuen said in May that at the same pace, costs would be "50% higher in five years and double within 10," the South China Morning Post reported.

People pay for that increase in different ways. Policyholders see it in their premiums. People without a policy pay the full bill at a private clinic or wait in a public system that the government says it can no longer keep funding at this rate.

For older residents, the price of joining rises steeply with age. Researchers at the University of Hong Kong's School of Public Health analysed 7,184 annual premium rates from all 31 providers of Voluntary Health Insurance Scheme standard plans in 2024. They found a mean premium of US$1,443 (about HK$11,300) for ages 60 to 70, and US$2,224 (about HK$17,300) for ages 70 to 80. That is a 54% jump from age alone, before any repricing for medical inflation. Three providers charged higher rates to people who first bought cover after 60 or 65.

Cheung's proposed answer looks north. He said the regulator supports annuity plans that would let residents retire in mainland China. That would require linking welfare payment systems, sharing medical records and arranging cross-border ambulance transfers back to Hong Kong.

The regulator is also carrying out a market-wide review of medical insurance pricing and benefits, building an industry dataset on premiums and claims. Cheung is due to speak again on Friday at the Asian Insurance Forum.

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