HKU Study Highlights Cross-Border Healthcare Challenges

An interdisciplinary research team led by The University of Hong Kong (HKU) has shed light on the critical role of cross-border healthcare in enhancing the wellbeing and mobility of Hong Kong residents within the Guangdong–Hong Kong–Macao Greater Bay Area (GBA). Funded by the Strategic Public Policy Research Funding Scheme of the Chief Executive's Policy Unit, the three-year study underscores the significant role of cross-border healthcare in enhancing Hong Kong residents' wellbeing and mobility (especially cross-border retirement). However, persistent challenges remain in accessing medical information, service delivery models, healthcare affordability, and policy coordination between the two healthcare systems—highlighting the need for policy innovations in both the near and long term.

The research was led by Professor Shenjing He, Head of the Department of Urban Planning and Design and Director of the Social Infrastructure for Equity and Wellbeing (SIEW) Lab at HKU. Co-investigators included Professor Anthony G.O. Yeh, Chair Professor in the Department of Urban Planning and Design and Director of the Centre of Urban Studies and Urban Planning at HKU; Professor Kenneth M.C. Cheung, Chief Executive of HKU–Shenzhen Hospital and Chair Professor in the Department of Orthopaedics and Traumatology at HKU; Professor Anne W.M. Lee, Deputy Chief Executive of HKU–Shenzhen Hospital and Chief of Service at the Center of Clinical Oncology, HKU–Shenzhen Hospital; Professor Linwei Tian from the School of Public Health, HKU; Professor Junhang Luo from the First Affiliated Hospital of Sun Yat-sen University; Professor Guanghui Dong from the School of Public Health at Sun Yat-sen University; Professor Jiawen Yang from the School of Urban Planning and Design at Peking University; and Professor Xiaohu Zhang from the Department of Urban Planning and Design at HKU. Professor Grace Tang, Honorary University Fellow of HKU and Founding Chief Executive of HKU–Shenzhen Hospital, served as an advisor to the project.

The study surveyed 3,500 Hong Kong residents living in Hong Kong, Shenzhen, and Guangzhou; conducted in-depth interviews with 140 Hong Kong residents, 40 healthcare professionals, and 20 government officials from Hong Kong and mainland China; and organised nine focus group discussions.

Key Findings

1. Growing Utilization and Improved Perception – Increased use of mainland healthcare by Hong Kong residents, with direct users reporting higher quality acceptance. The questionnaire survey results show that among respondents who had used mainland healthcare services, the proportion who expressed satisfaction with the quality of mainland healthcare increased from 54.7% before use to 73% after use.
2. Information Barriers as Primary Concern – Limited understanding of mainland healthcare systems fuels reluctance and apprehension.
3. Divergent Concerns Between Users and Non-Users – Non-users worry about unfamiliar procedures and costs; users value shorter waiting times but raise affordability and quality concerns. Not being covered by mainland medical insurance is an important reason for concerns about healthcare costs. The survey results show that among respondents who had used mainland healthcare services, only 8% had purchased the Urban Employee Basic Medical Insurance, and 5% had purchased the Urban-Rural Resident Basic Medical Insurance.
4. User Profiles – Residents with mainland experience, Mandarin skills, proactive health-seeking behaviour, and strong social networks are more likely to use cross-border healthcare.
5. Service Preferences – Demand for specialties with long public-sector waits (e.g., emergency care, orthopaedics) or high private costs (e.g., dentistry).
6. Diverse Service Models in the GBA – Multiple models exist (e.g., Hong Kong-operated hospitals, telemedicine), but disparities in capacity and competitiveness persist.
7. Multi-Sectoral Policy Involvement – Cross-border healthcare policies lack coordination, transparency, and professional management.
8. Impacts on Mobility and Wellbeing – Improved access boosts retirement intentions and wellbeing, especially for chronic or mental health conditions. Regarding cross-border retirement, a combined analysis using Agent-Based Modelling and Structural Equation Models based on the survey data shows that for every one-level increase (on a five-point scale) in respondents' satisfaction with cross-border healthcare, their willingness of participating in cross-border retirement plans increases by 12%.

Policy Recommendations

The study outlines both short-term priorities and a long-term policy framework to address these challenges. Recent initiatives, such as the GBA Medicines and Medical Devices Connect scheme and elderly healthcare vouchers, have made progress, but further measures are needed.

Short-Term Policy Priorities

1. Establishing a cross-border healthcare information platform to improve transparency and accessibility. The HKU research team is currently developing the "Healthy GBA" information platform and plans to launch its web version https://healthygba.hku.hk/ on October 1, 2025. Residents are cordially invited to pre-register for a trial at https://docs.google.com/forms/d/e/1FAIpQLSe-qeBsVuNX9sTgOQD5NQFn_8Y9Jxd-imxe4tAXDGe-xhqZPw/viewform?usp=header.
2. Addressing cost concerns through expanded insurance coverage and subsidies.
3. Leveraging underutilized capacity in mainland hospitals to reduce waiting times for Hong Kong residents.
4. Developing diversified service models tailored to different socioeconomic groups.
5. Expanding cross-border healthcare services to other GBA cities, with a focus on Shenzhen and Guangzhou.

Long-Term Policy Framework

Building on short-term initiatives, a systematic governance framework should be established to enable sustainable, coordinated development between cross-border healthcare utilization and population mobility:

1. Strengthening coordination between Hong Kong's public and private sectors and mainland healthcare systems.
2. Facilitating two-way healthcare resource flows to position the GBA as an international medical tourism hub.
3. Integrating cross-border healthcare with elderly care, education, and tourism to enhance social infrastructure.
4. Introducing a dedicated policy framework to govern cross-border healthcare, covering quality control, professional licensing, and data sharing.