PolyU CPCE x GUM “Hong Kong Employee Health Insurance Index” Latest Update
Post-pandemic Minor Cases Drive Up Hospitalisation
Outpatient Cost Inflation Intensifies
CPCE
Media Release
2026-06-10
The College of Professional and Continuing Education of The Hong Kong Polytechnic University (PolyU CPCE), together with corporate employee benefits and MPF consultant GUM, released the latest quarterly update of the “Hong Kong Employee Health Insurance Index” covering data up to 2025 on 10 June 2026. This update shows that healthcare utilisation and costs continue to rise, indicating that employee medical insurance premiums are likely to continue the upward trend seen over the past two years.
Through quarterly updates, PolyU CPCE and GUM aim to comprehensively reflect actual utilisation, costs and premium trends of group medical insurance, enhance awareness of key drivers of medical expenditure, and enable smarter insurance planning to mitigate rising healthcare costs and achieve a win-win outcome for all stakeholders.
The Index consists of the Utilisation Index, Expense Index, and Premium Index, covering Hong Kong’s group medical insurance market from 2006 to 2025. Key findings are as follows:
Utilisation Index: Outpatient Demand Stabilising but Costs Rising; Inpatient Utilisation Surges 16.5%
The Utilisation Index covers both inpatient and outpatient plans, reflecting overall healthcare usage and workplace health conditions. Latest data show that outpatient utilisation growth has moderated, increasing from 131 in 2024 to 139 in 2025, indicating that demand has gradually normalised after the post-pandemic rebound. In contrast, inpatient utilisation continues to rise significantly, increasing from 273 in 2024 to 318, representing a 16.5% increase, reflecting strong demand for inpatient-related medical services.
Post-pandemic Shift in Inpatient Demand Structure; New Diagnostic Categories Emerging
Further analysis indicates that minor day procedures remain the key driver of rising inpatient utilisation, accounting for as much as 87% of inpatient cases in 2025, becoming the dominant trend.
Key growth areas include:
- Viral wart-related procedures: increased from 5.02 to 5.85 cases per 100 insured persons (+16.5%)
- Endoscopy-related procedures: increased from 3.66 to 3.74 (+2.2%)
In addition, ingrown nails, localised superficial swellings or lumps, and cellulitis entered the top ten inpatient diagnoses for the first time. Among these, ingrown nail cases average around HK$17,000 per claim, higher than endoscopy-related cases (approx. HK$13,000).
Dr Alexender Chiu, Senior Healthcare Executive, noted that certain benefit structures (e.g. outpatient or surgical limits) may create “induced demand”, encouraging more frequent tests or minor procedures and increasing the risk of overutilisation. He suggested the healthcare sector should strengthen gatekeeping to ensure appropriate use of resources.
Prof. Peter Yuen, Dean of PolyU CPCE, warned that if private medical insurance costs continue to grow at this pace, it could pose serious affordability challenges for employers.
Expense Index: Significant Rise in Outpatient Costs, Returning to Previous Peak Levels
The inpatient expense index decreased from 202 in 2024 to 178 (-11.9%), mainly due to the higher proportion of minor procedures, which lowered the average inpatient claim to HK$19,240.
By contrast, outpatient costs continued to rise:
- Outpatient expense index increased from 284 to 325
- Average cost per outpatient visit rose to HK$610 Notably,
non-network outpatient services saw sharp increases:
- General practitioner visits: +16.8%
- Specialist visits: +12.0%
- X-rays and laboratory tests: +10.1%
Overall, outpatient costs have rebounded to pre-decline peak levels seen in 2022, pushing the overall expense index up to 313 (+3.6%).
Dr Ben Fong, Director of the Centre for Ageing and Healthcare Management Research of PolyU CPCE, suggested that in light of rising costs and utilisation, insurers and providers should consider implementing stricter pre-authorisation mechanisms and enhance patient education to ensure treatments are medically necessary and avoid over-treatment.
Premium Index: Dual Drivers Push Premiums Higher; Resource Allocation Skewed Toward Mild Cases
On premiums, the inpatient premium index rose slightly to 414 (+0.7%), while the outpatient premium index surged significantly to 227 (+17.0%). As a result, the overall premium index increased from 282 in 2024 to 303, representing a rise of 7.4%.
A key concern is the imbalance in resource allocation. Approximately 65% of inpatient premiums are spent on low-severity, routine cases, with viral warts and endoscopy alone
accounting for 31% of total usage. In contrast, high-severity illnesses account for only around 16% of resources. This suggests that claims remain highly concentrated in low- complexity treatments.
Dr Gloria Siu, GUM Chief Executive Officer, emphasised that the post-pandemic healthcare market is undergoing a structural shift, with inpatient resources increasingly consumed by high-frequency, low-severity cases, while outpatient costs continue to rise. She highlighted the importance of optimising benefit design, promoting employee health management, and strengthening utilisation controls to ensure long-term financial sustainability and employee well-being.