Why choose a private hospital? Expected coverage rate of public medical insurance for common injury and illness cases: Gastrointestinal Endoscopy

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The imbalance between public and private healthcare systems in Hong Kong is significant. According to the Hospital Authority's annual report, public hospitals handle over 80% of inpatient cases, while private hospitals account for less than 20%. In other words, public hospitals are the primary choice for most Hong Kong residents. However, when examining the types of diseases among inpatients, we find that for certain conditions, such as gastritis and duodenitis, the majority of patients opt for private hospitals (see Note 1) to undergo endoscopic examinations, avoiding the long waiting times in the public healthcare system. This may also reflect the circumstances under which individuals with medical insurance typically choose to be admitted to private hospitals, with colonoscopy and gastroscopy being among the most common reasons. 10Life evaluates mass medical insurance based on various common injury and illness cases. We have consulted specialist doctors to understand the treatments and medical services involved in different conditions, enabling our actuaries to calculate the expected coverage ratio for these cases.

Medical services for inpatient endoscopic examinations:

The surgeon’s operation fees and the hospital’s operating room costs are the primary medical expenses. During the procedure, surgeons often perform polyp removal for patients.
Doctors extract tissue samples from the relevant organs for testing, making diagnostic-related costs another significant expense. Doctors also typically prescribe medication for patients. In mass medical insurance plans, these expenses are usually categorised under the "miscellaneous expenses" item.
Before admission and after discharge, patients usually have outpatient consultations with the attending surgeon. Consumers should also check whether their mass medical insurance plan includes coverage for this item and the coverage limit.
When the aforementioned coverage items reach their compensation limits, the Supplementary Major Medical Benefit will cover the remaining claim amount, though the insured may need to bear a portion of the medical expenses.

Below are the expected coverage ratios for colonoscopy and gastroscopy (inpatient) under various mass medical insurance products:

(In fact, 10Life has compared nearly 40 mass medical insurance products in the Hong Kong market. Due to space constraints, not all are listed here. For details, please refer to the 《Product Decoder 》 on the 10Life website or app.)

In addition to inpatient endoscopic examinations, 10Life has also calculated the expected coverage ratios for various other injuries and illnesses, conducting a multi-dimensional "stress test" for mass medical insurance. If you have any questions about mass medical insurance products, you can use the "Ask Anonymously" feature on the 10Life app to receive immediate opinions from multiple licensed advisors.

Note:

1. According to the Hospital Authority's Statistical Report (2016-2017), the number of inpatient discharges and deaths at institutions under the Hospital Authority (public hospitals) was 1,760,420, far exceeding the figure of 396,812 at private institutions (private hospitals). However, among these, diseases related to endoscopy* accounted for only 3% of cases in public hospitals, while they made up as much as 21% in private hospitals.

*Diseases related to endoscopy include: gastric and duodenal ulcers, gastritis and duodenitis, other diseases of the oesophagus, stomach, and duodenum, and other diseases of the intestines and peritoneum.

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.

Last updated: 9 Apr 2026

10Life Editorial Team

Our team of professional content researchers focussing on insurance

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10Life Editorial Team

Our team of professional content researchers focussing on insurance

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10Life Product Comparison and 10Life Insurance Ratings are developed by 10Life Financial Limited, an authorised insurance broker company licensed with the Insurance Authority under License Number FB1526. 10Life Product Comparison and 10Life Insurance Ratings are developed for generic customer segments using mathematical calculations based on product information, facts and data, and are not influenced by any partnerships with or fees received from insurance companies. Any information on 10Life Platform ("10Life Information"), including but not limited to Product Comparison, Product Ratings, Blog Articles are intended for general education purpose and reference only. None of the 10Life Information is intended, nor should they be considered or relied upon, as regulated advice, insurance, financial, investment or professional advice, recommendation, approval, endorsement, invitation or solicitation in respect of any insurance, financial or investment products. 10Life Information does not take into account your individual needs. Reading 10Life Information should not be considered as conducting a suitability assessment, and is not sufficient to form the basis of any decisions to purchase any insurance products. You should rely on information authorised by insurance companies, carry out your own research and/or seek independent advice from licensed intermediaries before purchasing any insurance products or making any insurance decisions. While reasonable effort is used when collecting, validating and updating 10Life Information from various channels, none of 10Life Group and its subsidiaries, affiliates, agents, directors, officers and employees will be responsible for any liability, claim or loss arising from or associated with you using 10Life Information. No warranty, representation or guarantee is given by 10Life Group and its subsidiaries on the accuracy, completeness and timeliness of the information. If you have any questions on 10Life Product Comparison and 10Life Insurance Ratings, please email us at enquiries@10life.com

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Why choose a private hospital? Expected coverage rate of public medical insurance for common injury and illness cases: Gastrointestinal endoscopy

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