Hong Kong: #16 in the 2024 World Index of Healthcare Innovation

Introduction

In the 2024 World Index of Healthcare Innovation, Hong Kong maintains its 16th place position from 2022. The region performs well in Fiscal Sustainability and Choice, ranking 16th and 5th respectively. This is largely due to its exceptionally low debt-to-GDP ratio of 10.5 percent and the extensive options available in the private insurance market. Conversely, Hong Kong faces challenges in the Quality dimension, where it ranks 22nd. Issues such as lengthy wait times, overcrowding, and a shortage of physicians plague its public healthcare system.

Background

Hong Kong, a Special Administrative Region of China since its handover from Great Britain in 1997, was established under the Treaty of Nanjing in 1842. The Sino-British Joint Declaration promised the preservation of Hong Kong’s economic and political systems for 50 years post-handover. However, the introduction of a national security law by China in 2020 has significantly altered its governance landscape.

Hong Kong’s healthcare mirrors a dual system approach. The public system, akin to the British National Health Service, offers subsidized healthcare, where residents pay a nominal fee of HKD 100 ($13 USD) per day for hospital stays, with the government covering the remaining 95 percent of costs. This system serves approximately 90 percent of inpatient and 30 percent of outpatient needs. Because of the heavy subsidy, the system is burdened by severe overcrowding and a critical shortage of medical professionals—a 2019 report by the South China Morning Post depicted the public healthcare system as “teetering on the brink.”

Concurrently, the private healthcare sector has expanded over the past 50 years and now serves 48 percent of the population who are covered by private insurance. This sector provides care through private hospitals and clinics, characterized by shorter wait times and greater access to advanced medical technology, leading to better health outcomes. In an effort to reduce strain on the public healthcare infrastructure, the government has been actively promoting private insurance schemes.

Private insurers in Hong Kong are required to offer at least one standardized plan that includes guaranteed renewal up to age 100, coverage for pre-existing conditions, and other essential benefits. Beyond these basic provisions, insurers can offer premium plans with additional benefits. The costs for these plans are unregulated, with average premiums around HKD 4,500 per year ($585 USD).

The Hong Kong healthcare system effectively integrates both socialized and free-market principles to manage the city-state’s health needs. The government’s role is primarily in regulation and subsidy of the public system, ensuring basic healthcare accessibility for all residents. Conversely, the private sector is driven by market forces and consumer choice, providing an alternative for those seeking higher service levels and quicker access. This bifurcated system allows for a broad spectrum of healthcare services, aiming to balance quality, accessibility, and sustainability in response to the growing demands of Hong Kong’s population.

Dimension Performance

Quality

Hong Kong’s ranking of 22nd in Quality is mixed: it ranks 30th in infrastructure and 27th in patient-centered care, but a respectable 15th in disease prevention and 12th in pandemic preparedness and response. The region is notably plagued by its chronically overcrowded public hospitals, which result in exceedingly long wait times for specialist consultations, sometimes extending to years. Despite these challenges, Hong Kong excels in acute care survival, particularly providing top-notch treatment for critical cardiovascular incidents such as heart attacks and strokes. Hong Kong also features a world-class pandemic surveillance system, owing to its previous experience with SARS epidemics.

Choice

Hong Kong ranks 5th for Choice. Their universal health insurance system offers a wide array of choices and makes care generally affordable (17th). However, the vast public system denies patients a choice of providers. In addition, the country ranks 30th in access to new treatments, a product of the system’s tight price controls.

Science & Technology

Currently ranked 20th overall, Hong Kong trails behind many countries in the Science and Technology dimension. It ranks 31st in medical advances and 20th in scientific discoveries. Additionally, Hong Kong lacks the robust health-related scientific community that is common in North America and Western Europe. The region places 9th in health digitization, due to above average electronic health record use and a digitally connected populace.

Fiscal Sustainability

A key strength of Hong Kong’s healthcare system is its dedicated focus on cost efficiency, which is evident in its 16th place ranking for Fiscal Sustainability. The region also stands near the top of the Index for national solvency, ranked 3rd, thanks to a low debt-to-GDP ratio of just 10.5 percent. Additionally, it ranks 13th in public health spending. Notably, in recent years, there has been a significant increase in public health expenditure, currently ranked 31st, aimed at alleviating the chronic overcrowding in public hospitals.