Why Hong Kongers are flocking to the mainland for healthcare

(By Caixin journalists Wen Simin, Chen Yiying and Guo Xin)

Hong Kong residents have long travelled north into Guangdong province for relatively cheaper luxuries like dining out, spa treatments and shopping. But increasingly moving up the list of reasons is healthcare, as more and more Hong Kongers seek out medical treatment on the Chinese mainland.

But Hong Kong boasts some of the best medical standards globally, and its residents have enjoyed the highest average life expectancy worldwide for seven consecutive years — 80.7 years for men and 86.8 years for women.

So, despite the Asian financial hub’s high-quality public hospitals and medical services, why are residents crossing the border to Shenzhen for medical care?

In neighbouring Shenzhen, Hong Kongers have become a common sight in medical institutions seeking out primarily non-emergency outpatient services, ranging from consumer-oriented treatments like cosmetic procedures and health check-ups to specialised care in dentistry, ophthalmology and traditional Chinese medicine.

The University of Hong Kong-Shenzhen Hospital (HKU-SZH), the first public comprehensive tertiary hospital in the Chinese mainland to collaborate with Hong Kong, received 40,493 outpatient visits from Hong Kong residents in the first quarter of this year, compared with 2,471 emergency visits and 1,197 inpatient stays.

Dr. Yu Sze Yuen, director of the Cross-Border Medical Affairs Office at HKU-SZH, told Caixin that most Hong Kong patients visiting the hospital opt for the general practice department.

“This is because general practice mainly deals with common chronic diseases such as diabetes, hypertension, and hyperlipidemia, and the number of patients with these long-term conditions is relatively large,” Yu said.

“With fast and affordable services, going to the mainland for medical treatment has become highly attractive,” said Wang Yuan, a 70-year-old Hong Kong local. Word-of-mouth among peers has made going north for medical care the latest trend for people his age.

Recently, Wang and his wife visited Shenzhen to get reading glasses. The couple bought a lightweight, well-fitting pair for 100 RMB (US$14), which would have set them back HK$500 (US$64) to HK$600 in Hong Kong.

“My wife also took the opportunity to have a troublesome wisdom tooth extracted in just 20 minutes,” Wang told Caixin. The inflamed tooth had caused her severe pain, and extraction by a private doctor in Hong Kong would have cost at least HK$4,000, excluding consultation and X-ray fees.

“Most health insurance plans do not cover dental treatments, so visits to private clinics or hospitals require full out-of-pocket payment,” he added.

Mainland hospitals often offer more affordable options for certain routine surgeries compared with private hospitals in Hong Kong. For example, elderly patients commonly suffer from knee osteoarthritis, and those with severe conditions often require knee replacement surgery. In Shenzhen, the average cost for this procedure is around HK$27,000, whereas in a private hospital in Hong Kong, the cost can exceed HK$100,000.

Traditional Chinese medicine has also become a major driver of Hong Kong residents seeking care on the mainland. In Shenzhen, many public hospitals provide traditional Chinese medicine services, including acupuncture, massage and cupping, at relatively low costs. In contrast, similar treatments in Hong Kong can be up to ten times more expensive, with the city’s public hospital system primarily offering Western medical treatments.

In more severe cases, people suffering from cancer or rare diseases have been increasingly travelling to the mainland for medical care. This trend has in part been due to innovative treatments available either exclusively or at a more affordable price tag: thanks to annual negotiations between private drug developers and mainland authorities, the prices of innovative drugs have been reduced by approximately 60%.

Although many Hong Kongers do not purchase mainland health insurance, the prices of drugs included in the national insurance list must be publicly listed online unless companies request confidentiality. This allows self-paying patients to buy these drugs at the same rates as those covered by insurance.

Lorlatinib, developed by Pfizer Inc., is the world’s first third-generation ALK inhibitor and was approved on the mainland in April 2022 for treating locally advanced or metastatic non-small cell lung cancer with anaplastic lymphoma kinase positivity. Lorlatinib was initially priced at 40,500 RMB per box, which includes thirty 100-milligram tablets. As of 2023, the drug was included in the national insurance list, leading to a significant price reduction to 15,804 RMB per box.

In Hong Kong, lorlatinib is classified as a self-funded medication. Even at public hospitals, the monthly cost can reach up to HK$45,000.

Nevertheless, data shows that the vast majority of Hong Kong residents still seek medical treatment locally. In 2020, there were 20.76 million outpatient visits in the city’s public healthcare system, accounting 30% of the total outpatient services, with the remaining 70% at private medical institutions.

In comparison, the HKU-SZH received an average of about 450 Hong Kong patients per day in the first quarter of 2024. Even when considering all types of medical institutions in the mainland, it is estimated that less than 1% of Hong Kong locals seek medical treatment across the border.

Hong Kong operates a dual-track healthcare system that combines both public and private services. The public system serves as a safety net, providing access to high-quality medical care for all citizens, including low-income individuals, while the private system caters to those with higher financial means, offering premium and expedited services but at a greater cost.

The city’s public system handles around 8 million specialist outpatient visits each year, including about 900,000 new cases annually. The system faces increasing demand amid a shortage of medical staff, placing considerable strain on government specialist clinics. Consequently, patients with relatively stable conditions currently experience a minimum waiting period of ten weeks for their initial specialist consultation.

Over the past decade, the Hong Kong government has incrementally boosted its investment in public healthcare. However, the rising demand for medical services spurred by an ageing population has presented mounting challenges for the system.

Long waiting times in public hospitals and the high cost of private care mean that patients without commercial health insurance miss the optimal window for treatment.

Today, the convenience of cross-border transportation means nearby cities such as Shenzhen offer an alternative, where treatments are often more cost-effective.

But seeking medical treatment on the mainland is more than just patients taking the initiative — the Hong Kong government is also playing a key role.

On 19 February, the Hong Kong Health Bureau announced an expansion of the Elderly Health Care Voucher (EHCV) Greater Bay Area Pilot Scheme. Starting in the third quarter of this year, residents 65 and older will be able to use their healthcare vouchers at seven hospitals and two dental clinics in Shenzhen, Guangzhou, Dongguan and Zhongshan.

The EHCV scheme offers an annual subsidy of HK$2,000 to permanent Hong Kong residents aged 65 and older, aimed at offsetting medical service fees at private healthcare institutions.

According to data from the Health Bureau, since the scheme was piloted at the HKU-SZH in 2015, nearly 16,000 people have utilised the vouchers over the past eight years. The scheme has facilitated over 160,000 visits, with total expenditure exceeding HK$50 million. The majority of the users are Hong Kong residents living in the mainland.

With people discovering significantly lower treatment costs compared with Hong Kong, some are now exploring enrollment in mainland medical insurance. Step-by-step guides on how Hong Kongers can enroll in insurance schemes have gained popularity on social media.

Overall, they have access to two main types of government medical insurance on the mainland: employee basic medical insurance and urban-rural resident basic medical insurance. Reasons for opting for mainland medical insurance include employment, conducting personal business, flexible employment arrangements, residency and studying on the mainland.

Among these, Hong Kong locals can access the flexible employment category of employee medical insurance and urban-rural resident basic medical insurance with just a mainland residence card, even after returning to Hong Kong.

This year marks the eighth consecutive year that Hong Kong resident Lin Yi has been enrolled in mainland medical insurance. Lin previously worked and resided in Shenzhen for six years, during which his company contributed to the five major social insurance programmes and the housing provident fund. Even after resigning in 2022 and returning to Hong Kong for the long term, Lin decided to continue paying for the mainland insurance, shifting his payment category from “working in the mainland” to “flexible employment”.

As a flexible employee without a Shenzhen household registration in 2022, Lin had two payment options. The first, covering medical and pension insurance, cost approximately 1,000 RMB per month, while the second option, at around 500 RMB per month, offered differing coverage and reimbursement rates. Lin ultimately chose the second-tier option.

According to 2018 data from Shenzhen’s social security system, the outpatient reimbursement rate for the second-tier medical insurance was about 80%, with a major illness reimbursement rate around 88%.

(Wang Yuan and Lin Yi are pseudonyms.)

Zhou Xinda, Hua Ang and Liu Yueling contributed to this story.

This article was first published by Caixin Global as “In Depth: Why Hong Kongers Are Flocking to the Mainland for Health Care”. Caixin Global is one of the most respected sources for macroeconomic, financial and business news and information about China.

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