“The standard of healthcare on the mainland is not lower than in Hong Kong,” he said. “Why can’t Hong Kong’s elderly use their healthcare vouchers in top mainland hospitals?”

Although one hospital across the border accepted the vouchers – the University of Hong Kong-Shenzhen Hospital – Tam said it was only convenient for those living in that city and that he wished they could be used elsewhere.

Cross-border cooperation on issues such as sharing health records, training mainland doctors on Hong Kong medicines and medical devices and some relaxation of regulations on licensing practitioners were among policies that would help plug the hole, professionals in the field and hospital operators said.

Residents have been strongly encouraged to seek business opportunities, employment, education and even retirement in the bay area, an ambitious central government scheme to link Hong Kong, Macau and nine cities in Guangdong province into an economic and business powerhouse.

Incentives ranging from tax cuts to recognition of professional qualifications have been rolled out to attract them.

Currently, those aged 65 and above account for 17 per cent of the Hongkongers living across the border.

Although Tam and his wife enjoy the low cost of living in provincial capital Guangzhou, paying 2,000 yuan (US$290) a month for their 800 sq ft flat, finding healthcare services – a necessity for the elderly – remained a “predicament”, he said, noting that travelling back to Hong Kong for treatment before the pandemic struck had never been an issue.

Earlier this year, he suffered acute gastrointestinal bleeding and had to fork out 24,000 yuan for a 10-day hospital stay on the mainland.

It was a heavy burden for the couple who survive on a monthly HK$8,120 (US$1,034) old-age living allowance provided by the Hong Kong government and have next to no savings.

“How much more [of a self-paid hospital stay] could I afford?” Tam said.

‘Nightmare after midnight’

For Christy Chan*, a freelance copywriter in her 50s who moved from Hong Kong to Guangzhou in 2021 to be with her husband and 15-year-old daughter, the hunt for medical help one night was a nightmare.

She recalled bringing her daughter, who was suffering from a serious stomach ache, to two different public hospitals – only to be told to wait for hours.

“We eventually visited a private hospital, which charged us 2,500 yuan because there was a surcharge for admission after midnight,” said Chan, whose husband works in the city and daughter studies there.

“My husband’s company insurance could cover 80 per cent of the expenses, but the claims are not always successful.”

Chan said she wished the Hong Kong government could extend its subsidised consultation services beyond the border.

06:19

High hopes for China’s Greater Bay Area, but integrating 11 cities will pose challenges

High hopes for China’s Greater Bay Area, but integrating 11 cities will pose challenges

Although Hong Kong residents living in the bay area can buy basic government medical insurance, its coverage is very limited. Those seeking wider coverage must turn to private insurance.

A number of measures have been implemented to integrate the two healthcare systems in recent years, with the University of Hong Kong-Shenzhen Hospital being the main testing ground for pilot schemes. The 2,000-bed public hospital, which opened in 2012, was built by the Shenzhen municipal government and runs under a modern medical management model supported by the university.

In November 2020, a special support scheme was launched there for chronically ill patients from Hong Kong’s public hospitals who were stuck on the mainland because of the pandemic.

Under the scheme, they could receive subsidised follow-up consultations and opt to have their electronic medical records shared between the Hospital Authority and the Shenzhen facility.

A pilot scheme set to launch on May 10 is an extension of the 2020 initiative, potentially paving the way for authorities to subsidise healthcare services on a wider scale in the bay area.

Elderly Hong Kong residents have been allowed to use their healthcare vouchers to pay for outpatient services at the HKU-Shenzhen Hospital since 2015. Coverage was extended this month to a community clinic run by the hospital.

More than 32,000 healthcare voucher transactions at the Shenzhen facility, involving nearly HK$11 million, were handled last year.

Secretary for Health Lo Chung-mau, a former chief executive of the Shenzhen hospital, said the government was considering expanding the use of the vouchers to other facilities, adding priority would be given to healthcare centres that had a “Hong Kong management model”.

The government is also looking into allowing Hong Kong people to use the vouchers to pay for the premiums of mainland medical insurance under local social insurance plans across the border.

‘Bigger returns’

The only policy that went beyond the Shenzhen facility was the one granting special permission to use Hong Kong-registered drugs and common medical devices in designated mainland hospitals.

Nineteen hospitals, all Hong Kong-owned, have been granted this privilege since August 2021, allowing for 23 drugs and 13 medical devices to be used at those sites.

Two mainland hospitals, included on the list since February this year, have expressed an interest in working with the Hong Kong government to provide subsidised services to Hongkongers living in the bay area.

“Investing the same amount of money on the mainland could yield a bigger return because medical check-ups, consultations, and drugs are much cheaper here, even those in private hospitals,” said Dr Zhang Tao, superintendent of the Hong Kong-owned Clifford Hospital Guangzhou.

The 22-year-old private hospital was the first on the mainland to receive a JCI accreditation – a world-leading certification for patient safety and quality of care from the United States.

Both the Clifford Hospital and the HKU-Shenzhen Hospital are classified as Grade 3A facilities, the top tier on the mainland.

In pre-Covid times, Hong Kong residents made up 10 per cent of the Guangzhou hospital’s patients. Medical tour groups would often visit for cataract treatments and knee replacement surgery, which were far cheaper there and had no long waiting lists.

Zhang said the hospital was willing to let Hong Kong health authorities monitor prescriptions if the government bought services for Hongkongers on the mainland.

“The clinical diagnosis and treatment standards are largely the same across the world, if a diabetic patient only needs one dose of insulin, there is no chance we’d prescribe two,” she said.

“And if patients choose to receive therapies not available in Hong Kong, the government can simply not subsidise those therapies and let them pay.”

Mainland authorities had a comprehensive system to deal with medical disputes in the case of mishaps, Zhang said, pointing to bodies that handle cases such as the People’s Mediation Committee for Medical Disputes, as well as local courts.

“I have found the mainland system to be stricter than Hong Kong’s because we can hold doctors accountable by removing their licences, order compensation and even put them behind bars. This is not common in Hong Kong,” she said, adding that the Hong Kong government could also provide legal help.

Alex Jiang Li, vice-president of Shenzhen Hyzhen Hospital, stressed the need for more policy support to make cooperation successful.

“We are strong in will but weak in power,” Jiang said.

Founded in 2020, the hospital operates a hybrid model – investment comes from both the local government and private enterprises, some of which are from Hong Kong.

He said it was necessary to establish an electronic system to share the health records of patients within the bay area to save people from having to carry around paper documents or undergo check-ups all over again.

Efforts should also be made to manage Hongkongers’ expectations over pricing, as mainland medical services were not necessarily cheaper when surcharges were applied, Jiang said, giving the example of a 2,000 yuan deposit patients must provide when admitted to some hospitals.

“The price could be even higher if they are not covered by the mainland social security system, or if the hospitals they visit are not covered by their own private insurance,” Jiang said.

He proposed that Hong Kong send experts to carry out field assessments at mainland hospitals to improve cooperation. Such a move could help authorities identify shortcomings and minimise risks as much as possible, he said.

Both Zhang and Jiang voiced concerns over the insufficient experience of mainland doctors in using Hong Kong-registered drugs and medical devices.

“No mainland doctors have used those drugs before, nor have any mainland residents, so we are quite worried and dare not prescribe them,” said Zhang, who is also CEO of the Clifford Medical Group.

“But Hong Kong doctors have rich experience, it would be best if they could come here and lead us in the early stage.”

For a foreign drug to be registered on the mainland, it has to undergo years of clinical trials and assessments by health authorities, limiting the number of treatments available to patients, Zhang said.

But that process is curtailed to less than four months under the policy that allows Hong Kong-registered drugs to be granted special approval.

The hospital has applied for approval for seven drugs registered in Hong Kong, including ones for oncology, cardiology, obstetrics and gynaecology, among others.

Jiang echoed the call, saying he hoped some Hong Kong medical professionals could provide training for their doctors so they could learn from practical experience.

The hospital also established a rule requiring doctors to speak with a number of experts before prescribing those drugs.

Building trust

Dr Donald Li Kwok-tung, chairman of Hong Kong’s Elderly Commission and a family medicine specialist who has practised in a number of mainland cities, suggested the government support patients by applying its primary care model in the bay area.

“The Hong Kong government could just treat Shenzhen and other bay area cities as another district when providing subsidised services,” he said, referring to the city’s district health centre system.

Li said the government could directly buy services from private clinics in the bay area and let Hongkongers consult doctors for Hong Kong price levels, while allowing wider application of the elderly healthcare vouchers. The two parties would agree on consultation fees that were affordable to Hongkongers, who would pay the discounted prices to the clinics.

Those clinics should meet relevant quality standards and maintain transparency in pricing, he said, adding the government should consider mainland clinics with international accreditations in addition to those opened by Hong Kong doctors.

“What remains unclear is the practical solutions to medical disputes, what can they do if there is litigation, or if they want to file a complaint,” Li said, noting that the mainland did not have an open system to handle such disputes.

From his observations, he said, most Hongkongers could manage their chronic illnesses on the mainland. But they opted to transfer to Hong Kong when their conditions worsened because of a lack of confidence.

“Hongkongers do not yet have 100 per cent confidence in mainland medical professionals, because they are not familiar with the system,” he said.

“So it’s important to build trust and confidence, we [Hong Kong doctors] have been providing training to mainland doctors. Many clinics are also seeking accreditations to improve their credibility.”

Li said he wished authorities could step up education efforts to let patients know the options they had for acute emergency services on the mainland, to prevent them from delaying treatment.

Former health secretary Ko Wing-man said he did not expect big challenges in expanding subsidised services to other healthcare providers in the bay area that had a Hong Kong background.

“Hong Kong has been doing this form of partnership with private clinics for primary care purposes. If the same Hong Kong doctor opens another clinic in Shenzhen, what’s the difference?” he said.

Ko noted that Hong Kong-funded hospitals and clinics were familiar with the city’s electronic systems, which were crucial for accessing patient records and healthcare vouchers for the elderly.

As such, other mainland hospitals with no links to the city would need to upgrade their clinical information systems before being able to provide subsidised medical services to Hongkongers, he said.

“Now, I wish to push forward integration from the bottom upwards by encouraging more Hong Kong doctors and medical groups to enter the bay area market … it would be better if the mainland authorities could relax the licensing regime.”

Under the Closer Economic Partnership Arrangement, a free-trade deal which Hong Kong negotiated with the central government, doctors from the city without mainland qualifications can work for up to three years across the border using a renewable licence, but they must stay with a fixed number of healthcare providers.

They may be exempt from the requirement if they pass the mainland’s licensing exam.

Only those who have practised for five years in Hong Kong before 2008, and have obtained specialist qualifications, can directly apply for mainland qualifications without doing the exam.

Ko said he believed the current arrangement hardly encouraged younger doctors to practise in the bay area and called for the rules to be relaxed.

General surgery specialist Dr Ricky Chan Wai-keung is looking at ways to cooperate with Hong Kong-funded healthcare providers in the bay area. Chan said he had been looking to open a clinic there since 2019, but put the plan on hold.

Rather than visiting clinics, Chan said, mainlanders mostly preferred using hospitals that were Grade 3A, a level Hong Kong medical groups could not easily achieve in a short time.

But more doctors could be encouraged to practise on the mainland if healthcare benefits were expanded to cover Hongkongers living in the bay area, which would create demand for Hong Kong-style services, he said.

Patients were also concerned about whether insurance would cover the costs, as Hong Kong healthcare services were seen as more expensive, Chan noted.

“Doctors who choose to practise on the mainland can contribute to the country, further develop clinical skills, and expand their networks across the border,” he said. “But they should not care too much about their income, as medical costs are a lot lower on the mainland.”

*Name changed at interviewee’s request