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Figure 3.2
Current health expenditure by financing schemes, 2019/20

1.2%
52.9%

29.6%

16.3%

Government schemes Out-of-pocket payment
Insurance Schemes Others

Source: FHB, 2021a

Cross-national evidence shows that levels of OOP spending is an important indicator of
equity in healthcare access and is a marker of a country’s progress towards UHC (Xu et al.,
2003). Whilst China and Singapore have been attempting to reduce their OOP share of
current health expenditure as a positive move towards attaining UHC, Hong Kong’s OOP
expenditure has increased by 2% from its lowest at 29.6% in 2002 to 31.6% in 2018
(Figure 3.3).

As the majority of the total OOP expenditure is from the spending on private outpatient care
and medical goods (63.7% in 2019), the large OOP may not have the same impact on
catastrophic payment which usually results from high OOP for specialist services and
hospitalisation (Saksena et al., 2010). Nevertheless, OOPs is the main financing method of
private out-patient care in Hong Kong, accounting for over half of its spending, which
discourages usage among low-income people and leads to pro-rich inequity in access to
primary care. It was reported that approximately 8.4% of a Hong Kong population did not
seek medical care due to lack of financial means in 2017 (Wong et al., 2018). The lack of
primary care may result in worse health outcomes and incur larger health spending in the
future. Taken together, this high share of OOP spending is a signal that our health system’s
financial protection function may be inadequate and may impede progress towards achieving
UHC.

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