Year 2015 - The New Challenges of Insurance Regulatory Reform 保險業新規管 帶來的新機遇

專題探討 FEATURE The Hong Kong Government had conducted many rounds of Healthcare Reform public consultations since 1990’s, including 1993 “Towards Better Health”, 1999 “Improving Hong Kong’s Health Care System - Why & for Whom?”, 2000 “Lifelong Investment in Health”, 2008 “Your Health, Your Life” and 2010 “My Health, My Choice”. This round of Consultation Document is named “Voluntary Health Insurance Scheme” (“VHIS”). According to OECD, the size of global middle class will increase from 1.8 billion in 2000 to 3.2 billion by 2020, and 4.9 billion by 2030. Almost all of this growth will take place in Asia. It is disappointed that the VHIS Consultation Document is unable to look after the consumer rights of the majority of middle class in HK to choose their appropriate hospital insurances. This Document is only talking about “Hospital” Insurance and not really “Health” Insurance (as the name suggested) which should include inpatient & outpatient medical insurances, preventive & rehabilitation medical healthcare. The limit of benefits under the VHIS is far too low to be acceptable by most of the middle class in HK. The premium cost suggested in the paper is outdated. It is only up to year 2012. After a compound rate of medical inflation from 2012, the projected premium cost will be much more expensive than the average premium of HK$3,600. The Document projects that assuming the Legislative Council will pass VHIS in 2016, it will attract about 223,000 people initially and in the long run about half a million of people. The consequence of this VHIS is after the launch of this VHIS, middle class consumers who do not want to buy this VHIS, will have no or limited choices to buy their own higher limit hospital insurance. By then, all private hospital insurances allowed in the HK market will have to comply with the minimum requirements. Most of the middle class will face the problem of not affording to buy nor able to find their own suitable hospital insurances. Consumers will face issues of UNAFFORDABILITY, UNAVAILABILITY & UNACCESSIBILITY. The following are areas where revision required in this Consultation Document: A. Insufficient Limit of Benefit in the Standard Plan (VHIS) The current proposed maximum benefits per surgery for hospital surgery inclusive of doctor’s fee, operating theatre, anaesthetist fee of HK$58,000 is highly insufficient to cover most of our hospital operations in today’s hospital cost. Unless the limit per surgery is high enough to cover most the hospital operation, it is unlikely that middle class will join VHIS. B. The 12 Minimum Requirements Some minimum requirements are good practices and recommended to carry out as the best Codes of Practice in all medical insurance (not just hospital insurance). However, to impose all these minimum requirements without variation will stifle the hospital insurance market, will jeopardize our consumer rights of choice and eventually will drive most of the middle class back to the Public Health System. 1. Guaranteed renewal Yes, support 2. No “lifetime benefit limit” Yes, support 3. Coverage of pre-existing conditions No, strong objection. Consumer rights of choice and cost implication. See details below 4. Guaranteed acceptance with premium loading capped at 200% of standard premium for all ages within the first year of the VHIS launch, and those aged 40 or below starting from the second year of implementation of VHIS No, strong objection to impose citizens with age over 40 in buying VHIS in the 1st year of launch 5. Portable insurance policy - Only applicable within VHIS Standard Plan. - Major concern to apply to market outside VHIS due to cost implication to consumers The Currently Proposed “Voluntary Health Insurance Scheme” will Jeopardize Our Consumer Rights in Hong Kong 22 2014 年刊與 2015 展望 YEARBOOK 2014 & PROSPECT 2015