Hong Kong residents migrating north for better healthcare

Patients wait for treatment at the Hong Kong-Macao Residents Healthcare Service Center in Guangzhou, Guangdong province, on Aug 30, 2022. It is the first collaboration center in the Chinese mainland between medical institutions from Guangdong and Hong Kong. (CHEN CHUHONG/CHINA NEWS SERVICE)

Hong Kong resident Cheung Yiu-fu is frustrated with the city's healthcare system and has been traveling across the border to Shenzhen in Guangdong province for dental treatment since June last year.

The border crossing, closed during the COVID-19 pandemic, opened in early January 2023 after the travel restrictions imposed to control the virus were eased.

"I have come to Shenzhen several times for teeth implant surgery. The quality of service is quite good, and the price is much cheaper than in Hong Kong," the 69-year-old said, adding that he has recommended the healthcare services across the border to six of his friends.

Cheung has also traveled to Guangzhou, the provincial capital of Guangdong, to see a doctor for treatment of heart disease after consultation at a Hong Kong hospital.

"The Hong Kong hospital told me that I would have to wait up to four years for the operation. In the Guangzhou hospital, the doctor arranged the operation for me at once," he said.

Seeing a doctor in a Hong Kong public hospital is difficult for many of the city's residents. The excessive burden on medical resources means lengthy waiting periods and unsatisfactory experiences for many of Hong Kong's 7.5 million inhabitants.

The migration northward for medical treatment, follows the trend of Hong Kong residents traveling to Shenzhen for dining, shopping, and entertainment.

In total, more than 53 million trips were made by residents across the border last year, according to Hong Kong's Immigration Department.

To cater to the growing demand from Hong Kong, some medical institutions have launched shuttle buses at border checkpoints to transport patients to hospitals in Shenzhen. Others have opened online appointment channels to make the visits more convenient.

Shuttle buses between Shenzhen and Hong Kong wait to depart from Huanggang Port in Shenzhen. (LI ZHIHUA/CHINA NEWS SERVICE)

City's stressed system

Hong Kong patients have been struggling to get adequate medical services in local public hospitals as insufficient resources have led to prolonged waits of up to several years.

In specialist outpatient clinics, a triage system is implemented to ensure that patients needing urgent treatment are given priority. New patients are classified into urgent, semi-urgent, and stable categories.

For patients classified as in a stable condition, the medium waiting time for surgery is 26 to 59 weeks, while those classified as urgent wait less than a week.

The lengthy waiting times for some patients have forced many of them to turn to private hospitals, but the high prices they charge are prohibitive for the majority.

Hong Kong's public healthcare system boasts some of the most generous subsidies in the world, with the local government bearing roughly 95 percent of inpatient and clinical expenses. General consultations at public hospitals are HK$50 ($6.40) and specialist consultation fees are HK$80 for non-first-time local patients, according to official health data. Inpatient service costs are HK$100 to HK$120 per day.

By comparison, medical costs in private hospitals are staggeringly expensive.

A Hong Kong woman, who asked to be identified as Miss Chan, said she went to a Shenzhen hospital for a gastroscopy, which cost her less than 1,000 yuan ($140). The cost of the same examination in a Hong Kong private hospital could be 10 times higher, she said.

"Going north for medical treatment has become a new trend to fulfill medical needs in an affordable and high-quality way," said Wong Kwok, chairman of the Hong Kong Federation of Trade Unions and a member of the city's Legislative Council.

"Just like the recent upsurge of Hong Kong people going to Shenzhen for meals, goods, and services, cross-border medical cooperation is an obvious trend, and the idea of 'welfare portability' should be strengthened and accelerated."

A general practitioner examines a patient at the health service center for Hong Kong and Macao residents in Guangzhou in August 2022. (CHEN CHUHONG/CHINA NEWS SERVICE)

Confidence in services

The three major reasons Hong Kong patients visit Shenzhen are the cheap prices, the high quality of services, and the good experience, said Yu Sze-yuen, director of the office for cross-border healthcare services at the University of Hong Kong-Shenzhen Hospital.

Yu said Hong Kong patients paid 138,000 visits to the hospital between February 2023 and February 2024.

The number of visits by Hong Kong patients to the hospital's outpatient department reached 40,493 in the first quarter of this year, accounting for 10.4 percent of the total.

Hong Kong patients also made 2,471 visits to the Shenzhen hospital's emergency department, while visits for physical examinations and inpatient services were 1,264 and 1,197, respectively, over the period.

According to Zheng Yuyan, director of the Stomatology Center at Shenzhen People's Hospital, Hong Kong residents accounted for 5 percent of the total number of patients in 2023, and the proportion is expected to rise this year because of the heating up northbound trend.

The Stomatology Center is one of the most popular departments chosen by Hong Kong residents due to its cost advantage compared with dental clinics in Hong Kong offering similar medical services.

"At present, the Stomatology Center has nurses who can speak Cantonese and English at the guidance desk. Doctors also conduct online patient group chats for communication after treatment and plan to open an online consultation channel for Hong Kong residents in the future," said Zheng.

Chen Xiaoqiong, deputy general manager of CKJ, a dental organization in Shenzhen, believes the consumption patterns of Hong Kong residents have changed a lot since the border reopening. "Thanks to improvements in the transport network and the development of digital payments, it has become much easier and more convenient for Hong Kong residents to travel to Shenzhen."

Chen said HK residents have gained more knowledge about the mainland and "the convenience of healthcare there".

CKJ received over 40,000 visits by Hong Kong patients in the first quarter of this year.

"The average monthly number of visits by Hong Kong patients this year stands at 14,000, compared with 10,000 last year, so we can see that the number is on the rise," she said.

Path smoothed

To make it easier for its residents to get more affordable healthcare across the border, the Hong Kong Special Administrative Region government has launched several initiatives in recent years.

In February, it announced the extension of the Elderly Health Care Voucher GBA(Greater Bay Area) Pilot Scheme, which lets eligible elderly people use healthcare vouchers to pay for cross-border outpatient healthcare services. It now covers a total of nine medical institutions, including CKJ, in the GBA.

Seven medical institutions in Guangzhou, Shenzhen, Dongguan, and Zhongshan were added to the program, which is expected to benefit up to 1.7 million Hong Kong people.

In March, Hong Kong's Health Bureau announced that the Pilot Scheme for Supporting Patients of the Hospital Authority in the GBA would be extended for another 12 months.

Under the scheme, which was launched in May 2023, eligible patients only need to pay a 100-yuan consultation fee at the University of Hong Kong-Shenzhen Hospital. The remainder of the fee, up to a 2,000-yuan limit, is subsidized by the government.

Over 4,000 Hong Kong patients had enrolled in the scheme by the end of February.

In 2021, the Hong Kong and Macao Medicine and Equipment Connect program was introduced. It allows medicine and medical devices that are already on the Hong Kong market to be used in designated medical institutions in the Guangdong-Hong Kong-Macao Greater Bay Area after approval.

As of mid-January, 28 drugs and 28 medical equipment items had secured approval for use in 19 medical institutions.

Wong, from the Federation of Trade Unions, said cross-border medical cooperation is at a preliminary stage, and added that "overall progress has to be accelerated".

The elderly healthcare voucher scheme, for example, should be expanded to 3A hospitals or accredited private medical institutions in GBA cities, where more and more Hong Kong people have chosen to settle or retire, he said.

"The recent announcement of seven more GBA medical institutions to be included in the EHCV GBA Pilot Scheme merely widens the door to 'welfare portability'. There is still a lot of work to be done in the overall integration of medical systems between the two places," Wong said.

As early as 2022, Macao's medical insurance subsidies were extended to nine GBA cities for residents aged 65 or above, or below 10, primary and secondary school students, and people with disabilities.

"Now that Macao can do it, so can Hong Kong," Wong said.

Integration key

HKSAR Chief Executive John Lee Ka-chiu stressed the importance of making good use of healthcare services in the GBA in his 2023 Policy Address delivered in October.

The city's Secretary for Health, Lo Chung-mau, said the HKSAR government is exploring arrangements with suitable GBA healthcare institutions for purchasing healthcare services.

"The initial idea is to start with healthcare services with immense demand and lower risks, such as investigation or imaging services, and devise a service model for the purchase and specific arrangements under the premise of compliance with the relevant laws and regulations of both places," Lo said in May.

He said the HKSAR government will continue to monitor the progress of various cross-border healthcare collaboration initiatives. It will also explore feasible measures to support the medical needs of Hong Kong residents more effectively, he added.

"The government's policy objective is to enable Hong Kong people who travel between or reside in the two places and some of those who intend to settle in the GBA, to reside and integrate into local life, instead of solely relying on healthcare resources on the mainland to meet the needs of Hong Kong people," Lo said.

The HKSAR government is also discussing with city governments the provision of cross-border ambulance services to enable point-to-point hospital transfers of patients.

At present, patients who need to be transferred from a Shenzhen hospital to one in Hong Kong have to leave the ambulance and clear customs before getting in another vehicle on the other side of the border, which is difficult for those in critical condition.

Yu, from the University of Hong Kong-Shenzhen Hospital, said the provision of cross-border ambulance services involves a large amount of paperwork that needs to be addressed by different government departments.

"Hong Kong and Guangdong have their own laws and regulations regarding customs clearance of people and vehicles, management of dangerous drugs and equipment, …which requires a lot of time for coordination," he said.

The governments on both sides are actively working on the matter and "hopefully, this service will be implemented within this year", Yu said.

Chen, from CKJ, believes cross-border healthcare will become a long-term trend and demand will grow as regional integration in the GBA further deepens.

However, there are challenges that need to be addressed in the process, she said.

Obstacles to overcome

Differences in laws and regulations between Hong Kong and the mainland present a major obstacle to medical integration.

"Licensing of physicians, insurance reimbursement policies, data privacy protection… all these issues require a sound regulatory system and mechanism," Chen said.

Language and cultural differences could also have an impact on cross-border medical services, she said. "How to enhance consumer trust is another problem that needs to be considered," Chen added.

While acknowledging that cross-border medical cooperation could help alleviate Hong Kong's healthcare burden, Wong believes more effort is needed from Hong Kong.

He called for reforming medical licensing examinations and bridging courses, so that veteran doctors from the mainland and abroad have channels to connect and align with Hong Kong professionals.

"To alleviate the manpower shortage, it is suggested that Hong Kong establish an 'associate doctor' system through the promotion of limited registration for both overseas medical talents, and those who have been already practicing as a 'community doctor' in the city," he said.

"With these pragmatic adjustments, the system could better utilize these professionals and effectively protect the rights of patients," he added.

Yi Yang in Shenzhen contributed to this story.