Information Barriers to Hong Kong Residents' Cross-Border Healthcare Utilization in the Guangdong-Hong Kong-Macao Greater Bay Area and Potential Policy Responses

"Shaping a healthy Greater Bay Area" has been positioned as a key policy agenda in the Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area, issued by the central government in 2019. However, difficulties and uncertainties in accessing healthcare services have long been a major concern for Hong Kong (HK) residents wishing to work or live in mainland China. Information barriers to mainland China's healthcare services have become a primary obstacle for HK residents' cross-border healthcare utilization, while related studies remain scarce. This study aims to examine the extent of the information barrier, its variation among social groups, and its major causes, based on which we also seek potential policy responses. We conducted a large-scale survey of 3,500 HK residents in HK, Shenzhen, and Guangzhou in 2022, of which 2330 had never used mainland China's healthcare services before, and we asked them about their understanding of mainland China's healthcare quality, medical insurance schemes, and healthcare expenditures. Additionally, we conducted in-depth interviews with 129 HK residents, 42 medical professionals, and 14 officials in both HK and mainland China to gather their opinions on information barriers to cross-border healthcare utilization. Profound results were revealed through our mixed research approach: (1) HK residents generally lacked an understanding of mainland China's healthcare services. Only 4.98%, 2.26%, and 2.02% of respondents indicated that they were familiar with the hierarchy of healthcare quality, medical insurance schemes, and healthcare expenditures in mainland China, respectively, while 24.04%, 35.28%, and 37.68% stated they did not know these aspects. The understanding of medical insurance schemes and healthcare expenditures is even more limited compared to the hierarchy of healthcare quality. (2) Among others, middle-aged individuals (especially those aged 45-54 years), middle- and high-income families (with a monthly household income of more than 40,000 HK dollars), those who visit mainland China more frequently, and those with strong social networks in mainland China demonstrated a better understanding of mainland China's healthcare services. (3) These information barriers are the result of exacerbated healthcare information asymmetries amid the differences between HK and mainland healthcare systems and residents' healthcare utilization habits, which have long been unaddressed due to strict regulations on medical advertisements and social segregation between the two societies. Based on these findings, four potential policies are suggested to address these information barriers: (1) Establish a cross-sectional scheme to govern information on cross-border healthcare, with more proactive and integrated policy actions to promote various necessary healthcare information to HK residents; (2) Enrich the channels for promoting information on cross-border healthcare, such as providing an online platform compiling mainland China's healthcare information, promoting professional exchanges between HK and mainland China, and using virtual reality and other state-of-the-art technologies to enable HK residents to better understand the hospital environment and treatment procedures in mainland China; (3) Enhance policy attention to both healthcare quality and healthcare expenditures, with particular efforts to increase HK residents' healthcare affordability in mainland China; and (4) Employ different information dissemination strategies for different groups of HK residents and use those who already understand mainland China's healthcare services as proxies to accelerate information promotion.