Public or Private? The Ultimate and Only Doctor-Reviewed Guide to Pregnancy in Hong Kong

There’s a lot to think about when you get pregnant. In Hong Kong, we have a paradox of choice – we can choose from public, private and a mix of both health services when accessing pregnancy and birth care. Where do you start? With the expertise of Dr. Edmund Hon 韓慶璋醫生, an obstetrician who has worked in both the public and private systems, Healthy Matters brings you the most comprehensive guide to private and public pregnancy care in Hong Kong. This is the only doctor-reviewed guide available in Hong Kong.
 
 

System incentives

It’s important to understand the driving forces of each system to better decide which option you prefer.
 
PUBLIC – Like any country’s public healthcare, Hong Kong’s public system aims to offer accessible, quality and cost-efficient care to the population. The medical standard is very high but in order to offer comprehensive care to the entire population, it’s not full of creature-comforts.
 
PRIVATE – Private hospitals in Hong Kong operate as businesses. This means they do have an incentive to make money (whether as for- or not-for-profit), but also a strong customer-service model. When you access private care, you are a consumer making a choice over one facility or another so private hospitals compete on comfort, choice, wait times and quality of care.
 
 

Costs

PUBLIC – Prenatal and postnatal care is available free-of-charge at your local Maternal and Child Health Centre. Many MCHCs also offer pre- and postnatal classes, however the majority of them are conducted in Cantonese. Please contact your MCHC for details.
 
HK residents with a valid HKID are eligible to access subsidized obstetric services. In a public ward, childbirth costs $120 per day plus a $75 one-time administration charge, payable by Octopus card. These costs are all-inclusive and cover all eventualities – regardless of whether you have a completely medication-free birth or a c-section under anesthesia, you will pay the same price.
 
PRIVATE – The cost of private care varies substantially during pregnancy, birth and post-natal care. Private clinics (and even obstetricians within each clinic) set the price – most clinics can provide you a price list when you inquire about being an obstetric patient. Like clinics, the range of charges at a private hospital is substantial. Factors affecting the cost of giving birth in a private hospital include: vaginal vs. caesarean birth, the obstetrician’s labour fees, the anesthetist’s fees, the pediatrician’s fees, any medications, private vs. shared room, and food.
 
Insurance is the big decision point for most families when considering private care. Almost all maternity insurance schemes have a waiting period during which you cannot claim any maternity services. That being said, if your employer provides comprehensive employee medical benefits, the waiting period may have been waived. Whether your insurance is personal or through your employer, you should check the maternity waiting period terms and conditions. The pregnancy insurance waiting periods ranges from 9-18 months, with the market average at 12 months.
 
To provide a sense of the range of costs, below is a table of the range of hospital fees only for a vaginal birth and caesarean birth at Hong Kong’s private hospitals. The variation is accounted for by time/day of the week, number of nights in the hospital, emergency/planned c-section and a shared vs private room. Click on the link for each hospital for an in-depth breakdown of fees.
Private HospitalsVaginal Birth FeesC-section Birth Fees
Canossa Hospital $18,810 – $88,220$21,610 – $140,220
Gleneagles HK Hospital$19,800 – $42,800$25,800 – $62,300
Hong Kong Adventist Hospital $20,800 – $40,800$25,800 – $71,800
Hong Kong Baptist Hospital $20,800 – $48,000$23,000 – $55,000
Hong Kong Sanatorium & Hospital$22,300 – $38,600$28,800 – $55,200
Matilda International Hospital$21,500 – $49,500$29,500 – $100,500
Precious Blood Hospital$16,000 – $47,400$18,000 – $52,000
St Paul’s Hospital$15,000 – $47,000$18,000 – $ 45,000
St Teresa’s Hospital $14,800 – $35,800$16,800 – $39,800
Tsuen Wan Adventist Hospital$22,800 – $41,000$29,000 – $57,600
Union Hospital$20,000 – $35,000$31,800 – $55,300
* Last updated on 29 June 2018. Subject to change. 
 
In the private sector, doctors’ fees are correlated to the room type. In other words, the more expensive the room, the more expensive all the other fees. When planning your budget, adjust the doctors’ fees according to the room chosen – private, semi-private or standard – and ensure your budget or health insurance can accommodate an emergency C-section and other additional costs, like a birth on a public holiday. You will be paying for your obstetrician’s fees plus your anesthetist’s fees (if your require such services), and the pediatrician’s fees. Moreover, parents often forget to budget for prenatal and postnatal care, which is not included in the hospital or obstetrician’s delivery fees.
 
For a complete list of private obstetrician delivery packages, get the Hong Kong Maternity & Baby Book.
 
 

Shared care or the half-half route

Some women choose to combine public and private services during their pregnancy. This is known as either ‘shared care’ and the ‘half-half route’. Most commonly, women will access some private pre-natal services and give birth in a public hospital.
 
Some common private services women may access during pregnancy are:
  • Private consultations and ultrasounds with an obstetrician;
  • Additional testing (i.e. the NIPT blood test for chromosomal abnormalities at 9 weeks);
  • Private consultations with a midwife for additional ultrasounds or to discuss birth plans; and
  • A private and external midwife attending the birth (only some hospitals allow this if the midwife is attending as a companion of the patient and not as a member of the medical team).
The ‘half-half’ option gives patients the security of personalized medical care during pregnancy but the cost savings of giving birth in a public hospital.
 
 

Quality of medical care

Both the private and public options offer a very high standard-of-care in Hong Kong.
 
PUBLIC – Hong Kong’s Hospital Authority (HA) operates 10 obstetric wards and 31 Maternal and Child Health Centers across the SAR. Maternal and infant health care in Hong Kong is amongst the best in the world, with excellent maternal and infant mortality rates. Public obstetric wards are clean and very safe.
 
PRIVATE – There are 11 private obstetric wards in Hong Kong. The private hospitals in Hong Kong do not have the same stringent reporting requirements so unfortunately, there are few statistics available. That being said, they attract a very high standard of medical professionals, have fluent English speakers on-staff and have a financial incentive to provide a very high standard-of-care that is patient centered.
 
 

Neonatal Intensive Care and Neonatal Intensive Care Units (NICUs)

At present, public hospitals and the new private hospital Gleneagles can offer grades 2B and 3 NICUs, are best trained and equipped to handle neonatal emergencies.
Most other private hospitals in Hong Kong offer category 1 neonatal care and several hospitals also provide the category 2A neonatal care called Special Care Baby Unit (SCBU). Generally, premature deliveries at less than 34 weeks gestational age and certain high-risk births are only handled by public hospitals.
 
 

Freedom of choice of choosing your medical providers

PUBLIC – Going through the public system, you will be assigned to the obstetric ward in your local area and the closest MCHC associated with that hospital. The majority of your appointments will be in the MCHC, with only a few diagnostic tests (Down syndrome screening, fetal morphology and any other medically-necessary tests) conducted in-hospital. Public care for pregnancy and birth is, for the most part, midwife-led unless major complications arise, in which case, an obstetric team will be available. At every visit, you will see the midwife working in the MCHC or on the ward at the time.
 
PRIVATE – One of the primary benefits of going through the private system is the ‘continuity of care’ model. Using a private obstetrician means you will see the same doctor at every appointment throughout your pregnancy and, if you choose to give birth privately, during childbirth. You also get to select any other doctors present at your birth – the most common being your anesthetist and pediatrician. Your obstetrician may prefer working with some doctors and institutions, but you have the freedom to choose the hospital, anesthetist and pediatrician.
 
 

Wait times and waiting room during pregnancy

PUBLIC – In the public system, there are often long waiting times for your appointments in a crowded wait room. You will usually have 5 minutes with a midwife or obstetrician during which they will conduct any required tests. You will not have time to ask too many questions so it’s helpful to come to your appointment well-prepared.
 
PRIVATE – Like in any doctor’s office, despite having an appointment slot, it’s likely you will have to spend some time in your private doctor’s waiting room as well. This is often due to the obstetrician spending extra time with their patients to answer all their questions – take advantage and make sure you get your questions answered too. If you opt to, you will be given multiple opportunities to discuss your birth plan and labor options with your OB.
 
 

Consultations, tests and ultrasounds

PUBLIC – Going through the public system, you will have your routine antenatal checkups, plus medically-necessary testing and ultrasounds done. The following is a sample schedule for a normal, single, uncomplicated pregnancy:
 
  • 11-12 weeks – registration with your MCHC or hospital – you can expect blood tests and an ultrasound (often in 2 separate appointments)
  • 16 weeks – routine checkup and consultation with an obstetrician and midwife
  • 18 weeks – early Oral Glucose Tolerance Test (OGTT) for women who are at higher risk for diabetes only (those with a personal or family history or over 35 years)
  • 20 weeks – anatomic anomaly ultrasound
  • 24 weeks – routine checkup
  • 28 weeks – OGTT for all and Rh-negative injection if necessary
  • 30 – 32 weeks – routine checkup
  • 34 weeks – routine checkup and Rh-negative injection if necessary
  • 36 weeks – routine checkup and Strep B test
  • 37 weeks – routine checkup
  • 38 weeks – routine checkup
  • 39 weeks – routine checkup
  • 40 weeks – routine checkup and booking of induction in case of need
  • 41 weeks –  induction of labor if necessary
 
PRIVATE – In the private system, women usually have appointments every 4 weeks from 6 – 32 weeks; every 2 weeks from 32-36 weeks and every week from 36 weeks until the birth.  If it is an uncomplicated pregnancy, women will have the same schedule of tests and examinations. You may be offered an ultrasound at every appointment. Take note that the number and cost of prenatal consultations vary between doctors and increase if you have a high-risk pregnancy.
 
For a complete list of private sector prenatal care consultations and visits, get the Hong Kong Maternity & Baby Book.
 
 

Patient privacy

PUBLIC – Maternity wards host many women at one time in early labour. You may have a curtain separating you from your neighbor, but not always. The birthing suite is private but you will be in a shared ward once you have finished giving birth. It can get noisy!
 
PRIVATE – Private hospitals offer both shared and private room options and the level of privacy is much higher.
 
 

Freedom of choice – service and comfort during labor and birth

PUBLIC – The public system has a very high quality of medical services but is very much based on protocols of efficient and effective ‘best-practice’ and rarely deviates from anything medically-necessary. You can be sure to receive exemplary care but it’s unlikely you’ll be able to have a ‘personalized’ birth experience. You will be offered TENS machine, nitrous oxide, pethidine but if you request an epidural, you may not get it. Epidurals are not guaranteed in public hospitals. There may be a quota on epidurals and the anesthetist may not be available.
 
While they don’t provide them, some public hospitals will allow you to bring in items such as yoga/birthing balls. If this is important to you, bring it up in one of your prenatal visits to see what is and isn’t allowed.
 
Public wards do not allow partners in the maternity room though they are allowed in the birthing suite. They also restrict the number of people allowed in the birth suite; this is an important consideration if you’re considering having a private midwife assist you during childbirth. Each public hospital has a slightly different policy so it is best to check in advance under which circumstances your partner can be by your side.
 
PRIVATE – The private system runs on a customer-service model, meaning you are more likely to get a ‘personalised’ birth experience, deciding with your doctor whether and when you’d like certain interventions. Going private, you can either leave all decisions up to your physician or you can create a detailed birth plan. An anesthetist will be available within a reasonable amount of time should you request an epidural. Similar to public hospitals, it’s worth checking in with different hospitals to see what equipment they allow, what they already have on-site and what you should bring. Rules at each hospital differ but they generally offer more flexibility than going through public hospitals.
 
At the time of writing, no hospitals in Hong Kong (private or public) allow underwater births. Some private hospitals will offer a bathtub for early labour pain relief.
 
 

Caesarean sections

At 41%, Hong Kong’s caesarean section rate is much higher than the WHO’s recommended 10-15% rate. There is a rumour that if you go through the private hospital system, you will be pushed to have a caesarean even if it’s not medically-necessary; and if you go through the public system, you will either not be able to have a c-section or only be offered an emergency c-section in extremely dire situations. Privately, this is really dependent on the obstetrician you choose. All private OBs can do scheduled c-sections, but they vary on their preference of vaginal vs. c-section births. Finding an obstetrician who aligns with your birth preference is key when seeking out a private OB. In the public system, if a caesarean is medically necessary (both emergency and planned), they are readily conducted. Public hospitals do offer elective C-sections for medical reasons but they do not offer planned C-section for non-medical reasons.
 
 

Postnatal care – in hospital

Post-natal care in the hospital varies substantially between public and private hospitals. Mothers who have had uncomplicated vaginal births in a public hospital can expect to be in hospital for 1 day to recover post-birth; for uncomplicated c-sections, in-hospital recovery is 3 days. In private hospitals, it’s usually 3 and 5 days for uncomplicated vaginal and c-section births, respectively. In public hospitals, it’s important to be proactive if you have a concern or issue – nurses and midwives are knowledgeable and helpful but overstretched.
 
PUBLIC – The public obstetric wards are all at different stages of aiming for Baby-Friendly Health Facilities Designation (BFHFD). This means that as much as possible, babies will be placed on mother’s chest for skin-to-skin if possible after birth, help initiate breastfeeding after birth, and provide assistance with lactation issues. Unless medically necessary that they be put in the nursery, babies will room-in with mothers. Again, if you have issues or concerns while in hospital, speak up.
 
PRIVATE – As mentioned, the private system is based on a customer-service model. There are no private hospitals in Hong Kong working towards BFHFD but some hospitals are well-equipped to assist mothers with breastfeeding if that’s what they choose. Likewise, patients in private obstetric wards can choose either to have their newborns sleep in their room or in the nursery if they need to rest and recover from labour.
 
For more information on breastfeeding in public vs. private hospitals, see the Healthy Matters interview with breastfeeding expert, Dr. Marie Tarrant.
 
 

Postnatal care – out of hospital

PUBLIC – Post-natal care in the public system is accessed at the MCHC. You will have several scheduled check-ups for mother and baby and can access their services at any time if you have a concern with your recovery, the baby, or breastfeeding.
 
PRIVATE – The private post-natal options in Hong Kong are extensive, and many services are available at home or in-clinic. There is a huge range in cost for private services. Some examples of private postnatal services are:
  • Mother and baby clinics
  • Post-natal massage
  • Pui Yet or confinement nurses
  • Night nurses
  • Lactation consultants
For more details on pregnancy options and services in Hong Kong, get the Hong Kong Maternity & Baby Book.
 
This article was reviewed in April 2018 by Obstetrician Gynecologist Dr. Edmund Hon 韓慶璋醫生.
Dr. Edmund Hon 韓慶璋醫生 is an Obstetrician Gynecologist who received his medical training at the University of London Guy’s Medical School. He specialises in obstetrics and gynecology and has obtained advanced level in laparoscopic surgery. He started his private practice in 2008 after working for 12 years in public sector at Queen Mary Hospital 瑪麗醫院. He is currently Honorary Assistant Professor at the University of Hong Kong.
This article was independently written by Healthy Matters and not sponsored. It is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.