Hong Kong’s Health Care System Is Number One

Among developed countries, Hong Kong is so far out in front there isn’t even a close second. Or at least it would be if (a) it were still an independent country and (b) I used the measuring rods commonly used by critics of the US system, including the Commonwealth Fund, the World Health Organization, SiCKO and the Mercer/BRT study described below.

Why does Hong Kong rate so high? Because:

  • It has the lowest infant mortality rate in the whole world and the second highest life expectancy rates; and
  • At 5.2% of GDP, its health care spending is about half of the OECD average.

Also, all medical students are trained to use electronic medical records and, at least in the public hospitals, they actually use them.

So why aren’t we hearing about Hong Kong from Michael Moore, Hillary Clinton, Barack Obama and all the other critics of American health care? Maybe because Hong Kong has (a) one of the smallest public sectors (government spends only 55% of the total), (b) very little health insurance (only 12% of spending) and (c) the highest amount of out-of-pocket spending among developed countries (one out of every three dollars).

Basically in Hong Kong people can “purchase” public health care for very nominal fees, but potentially lengthy waits. For example, the average wait to see a specialist is more than 7 months. The average wait is 2 to 3 years for Lasik surgery and 4 to 5 years for cosmetic surgery. Or, patients can turn to much more pricey care in the private market. The public sector offers low money costs, but high waiting costs. The private sector offers high money costs with very little waiting.

So what is Hong Kong doing with its health care system? Trying to reform it, of course. To my knowledge, every government in the whole world is trying to reform its health care system – no matter how well it works, or doesn’t work.

Comments (8)

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  1. Bret says:

    John, when you said people’s IQs fall 15 points when they start talking about health policy, you were clearly wrong. I would say they fall about 30 points.

    Anyway, these last two posts give us ammunition to use when ever we hear the typical silliness on the left. Whenever they say Canada, we can say India. Or Hong Kong.

  2. Ken says:

    Yes, John. But as you have written in you books and other places infant mortality and life expectancy is not primarily determined by anything doctors do.

  3. Bruce says:

    The very low infant mortality rate is strange, especially when you consider that a great many births are by mothers from the mainland who are trying to get Hong Kong citizenship for their children.

    Also, these mothers have not benefited from any prenatal care — at least in Hong Kong.

  4. Stephen C. says:

    Let me guess. Hong Kong is thinking about “reform” by expanding the public sector. Right?

  5. Andrea says:

    Stumbling across this blog rather late, but not too late to correct some silliness I hope for people who land here later.

    As a Hong Kong resident, I don’t expect US reader to have any knowledge of how it works, but Stephen C’s biases show in a mere pair of quotation marks and makes me wonder if people of his mindset will be able to comprehend what I write below:

    Hong Kong’s healthcare system is taken wholesale from the UK’s NHS – it was a British colony for 155 years after all – with very few tweaks. So when I read American railing on about the evils of the socialized medicine yet praising Hong Kong, I laugh loudly. We proudly have a “socialist” healthcare system with virtually free healthcare yet top tax rates are 16%.

    80-90% of Hong Kong medical care takes place through the public healthcare system. Like the NHS, there is rationing through wait lists. The remaining 10-20% is through the private system and largely focuses on primary rather than hospital care. The top specialist units are all at the public teaching hospitals, although these do take on private patients too. Singapore and Australia follow quite similar public-private mixes.

    Where we differ from the UK is mostly through the moral dimension: We see nothing wrong with having to make a choice between pay or wait, whereas it appears most British people still feel that it is morally wrong to pay up for medical care and opt out of waiting lists. Less than 10% of the UK population has private medical insurance that would facilitate their ability to short circuit the wait for treatment through opting for private treatment – yet the option in both countries exists to the best of my knowledge.

    Medical costs are lower in HK precisely *because* the system rations care. People seem to accept that if you have, say, terminal cancer that a cutting edge treatment *might* help give you an extra 2-5 years of questionable quality of life at best, the public hospital and/or your insurance company may very well reject it and few people put up much of a fight. This is said to be the most capitalist society in the world: people seem to understand better that everything has a price and that not everyone can afford the luxury of choices.

    The reforms in Hong Kong are to address the projected rise in government costs as the population ages and poses more of a burden to the state healthcare system. The next generation will need to deal with the same problems faced by the UK, but for the moment the system is working extremely well for us.

    (As a consumer I’d add that doctors fees seem a lot lower here – visiting a GP normally costs US$30-50. If you are an expatriate or wealthy, you’ll pay at most US$150 for a doctor who only sees 1 or 2 patients per hour. )

  6. CB says:

    You ought to make sure your information is economically factual before you post it.

    Hong Kong has 50 public care hospitals to 12 private ones. It therefore operates under a very mixed health insurance industry. In fact, most of the specialists are located at the 50 public hospitals.

    From what I am reading by this Hong Kong national, the vast majority of the healthcare in Hong Kong is public, which correlates to what I see.

    Please don’t fill the net with falsities like this.

  7. lee du ploy says:


    The old Chinese proverb ” the colour of the cat is irrelevant its how many mice it catches ” ………….pollution and its subsequent by factors is the problem here for us who live in Hong Kong.
    We have no choice over breathing ,we are extricable linked to life through the air we breathe we dismiss its importance to our detriment.

    I am researching the subsequent consequences , stress anxiety,hypertension and its cousins and finally dementia, these are all linked in my opinion to air pollution.
    My specific research is into Prosopagnosia which occurs as a consequence of stroke , I have devoted a chapter to it in my new book “The Glass Facade” , I believe the biggest danger to the health system in HK is not the quality of the health care, not even the quantity of Hospitals or facilities but the effect of air pollution.

    lee du ploy

  8. JW Cheng says:

    As a practicing doctor in Hong Kong, I believe what Andrea said is quite accurate.

    Just to add on Andrea’s notes a bit.

    Yes there are more specialists in the public sector, and yes there are more public hospitals numerically. Yet only a handful of hospitals actually offer comprehensive services to the populace. Many of these so-called hospitals offer very limited services e.g. Obs and Gynae follow up, general medical outpatient FU etc, without inpatients. Therefore the more complicated cases are mostly treated by no more than 10 hospitals dispersed over our city, with the two teaching hospitals being the ultimate places for referral.

    Many doctors move to the private sector once they finish specialty training – for a better lifestyle and better income. Doctors here work for at least 75 hours a week and the pay is mostly just a fraction of that of private practitioners.

    I’m not sure how it works over at the US, but medical insurance covers the cost of many private clinics/surgeries – many private practitioners have prior arrangements with insurance companies on what they cover etc – though of course this insurance is not a national policy but paid on an individual basis.

    I don’t see any huge errors in Andrea’s estimations… though there’s a tough chance that anyone is still reading this post anyway.