Special Report – A universal healthcare insurance system?

Leading expert in health economics and finance notes that “It is not advisable to switch to universal healthcare insurance”, considering the advantages of the SAR’s healthcare model

Macau Business | November 2022 | Special Report | Macau’s insurance industry


A few months before the pandemic arrived in Macau, one of the most recurring themes in the Legislative Assembly was, as put by several legislators, the need to adopt a universal health insurance scheme to share the ever-increasing expenses of healthcare.

The costs that the new Island Medical Complex will bring to the SAR’s budget were discussed at the time, and the former Chief Executive even stated that “We have spent a very large budget on the health system over the years. We can see that there has been an increase, almost doubling our burden [supporting] the healthcare system. “

Chui Sai On went even further, advocating some of the benefits of universal health insurance: “In the implementation of universal insurance,” he said, “what is essential is whether the population is interested in contributing its share. The burden that is being borne by the government is not small. If we implement universal insurance, this implies the willingness of participants to adhere to the system. If the number of participants is not enough, it will pose a problem.”

At the end of 2019 Chui Sai On gave way to Ho Iat Seng and, above all, the COVID-19 pandemic surfaced.

The immediate result was that the topic disappeared from the agenda.

And even now that less revenue is coming into the MSAR budget and health expenditures have never been greater, the option for universal healthcare insurance has never been discussed again.

One of the city’s leading experts in health economics and finance, Jing Hua Zhang begins by stating that “There are several different ways of financing the health system in a community.”


“It will be difficult and unnecessary to switch the system” – Jing Hua Zhang

“While universal health insurance systems are one type of healthcare financing, the current system in Macau actually is a system of direct healthcare provision (social medicine), providing very comprehensive coverage and support to citizens. It has operated very efficiently when measured by many international health outcome and efficiency indicators,” adds the Professor from Macau University of Science and Technology.

“According to my analysis so far, Macau’s direct-providing system actually has the advantage of minimising the administration cost of healthcare insurance, as long as the tax revenue is sufficient,” stresses the Assistant Dean of MUST’s School of Business.

“In 2019, before the pandemic, I even suggested that the Macau government identify the potential vulnerable groups and conditions, especially expand the coverage of the security net to 1) the self-employed and 2) set the ceiling of healthcare burden for those who are not in the most disadvantageous groups…,” Mr Zhang confides.

“As far as I know, Macau government showed very positive attitudes to these suggestions. The outbreak of the pandemic has indeed postponed the progress of the reform. I believe these improvement measures will be optimal and efficient for healthcare system improvement in Macau, no matter with the epidemic or not, rather than switching to a universal healthcare insurance system,” the pundit tells to Macau Business, once “actually, to fight against the pandemic, public health even needs more direct healthcare providing as you may have observed.”

In the opinion of Professor Zhang, “it will be difficult and unnecessary to switch the system.”

“We economists always say ‘the decisions are made at the margin.’ Given the current status of the healthcare system in Macau, it is not advisable to switch to a universal healthcare insurance,” he concludes, believing that “the decision and suggestions should be made according to the cost-and-benefit analysis and evaluation of the performance of the system in existence.”


Health Insurance Subsidy Scheme

Last August, the Government of Macau decided to extend the Health Insurance Subsidy Scheme for Macau residents in Mainland China to the nine  Greater Bay Area.

Before that, the plan could only be used by residents living in Zhuhai, Zhongshan and Jiangmen, but those living in  Foshan, Guangzhou, Shenzhen, Dongguan, Huizhou and Zhaoqing have joined the scheme.

The scheme beneficiaries are residents aged 65 and above or aged ten years old and under. Also, primary and secondary school pupils or the disabled can apply.

In addition to having to live in one of the aforementioned cities, they need to hold a valid Mainland Resident Identity Card for Hong Kong and Macau residents alongside the Macau SAR Resident Identity Card.

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