Miss Lo, who has suffered from eczema for over twenty years, lives in the eastern New Territories. Since August this year, she has been regularly traveling to Shenzhen, a city in mainland China, to receive injections of biologic drugs at the University of Hong Kong-Shenzhen Hospital. Each round trip takes about three hours. The same medication is considered a self-paid treatment in Hong Kong, while the cost of an injection in Shenzhen is approximately one-third of the price in Hong Kong.
For her, this annual routine saves about 100,000 HKD, allowing her to see hope in treating a long-standing illness: “I can finally get a good night’s sleep.”
Biologic drugs are expensive self-paid treatments in Hong Kong. To afford regular injections at a reasonable price, Miss Lo is willing to make the frequent trips between Shenzhen and Hong Kong.
After the full reopening between Hong Kong and mainland China in February 2023 post-pandemic, it has become a trend for Hong Kong residents to travel north for shopping during holidays. Besides buying property and dining out, an increasing number of Hong Kong people are opting to go to Shenzhen for medical treatment. According to data from the Shenzhen Health Commission, Shenzhen provided 700,000 medical services to Hong Kong residents in 2023.
However, with more Hong Kong residents like Miss Lo traveling north for medical care, experts have warned about the differences in medical systems and associated legal risks between the two regions.
In addition to common services like dental care and physical examinations, there has been a rise in cancer and rare disease patients from Hong Kong going to Shenzhen to purchase "sky-high priced drugs" at significantly lower prices. Long waiting times at public hospitals and expensive fees at private hospitals in Hong Kong are among the factors driving people to seek medical care in Shenzhen.
“Now I can finally get a good night’s sleep.” According to the Eczema Concern Group in Hong Kong, it is estimated that over 500,000 people in Hong Kong suffer from moderate to severe eczema (atopic dermatitis). Miss Lo is one of those severely impacted, and at her worst, the skin on her feet was ulcerated, preventing her from walking, with wounds and bleeding occurring almost daily. “At the worst times, I would spend almost three hours each day dressing my wounds.”
In the past, Miss Lo had tried various treatment methods, including traditional Chinese medicine for about four to five years. "Later, I hit a bottleneck, and my condition became more erratic." Due to the long waiting times for dermatology appointments at public clinics, she had no intention of queuing, as it was simply too long. According to the Hong Kong Department of Health’s statistics on new skin disease appointments, the wait time can be at least two years or more.
Earlier this year, she learned about biologic drugs used to treat psoriasis and eczema, which can suppress the immune response and reduce inflammation. This sparked her interest in trying them.
However, to receive biologic injections at a public hospital in Hong Kong, one must first meet three conditions to obtain a referral: the condition must still be uncontrolled after trying two types of oral medications, traditional treatments must have caused severe adverse effects, and there should be no contraindications for receiving biologic treatments, in addition to facing long waiting times. If opting for private clinics, patients encounter high costs, with each injection costing between HKD 7,500 and 10,000, requiring regular treatments.
After finding out mid-year that she could receive biologic injections in Shenzhen, she applied for a phone number from mainland China. By using WeChat, she successfully registered for an appointment at the University of Hong Kong-Shenzhen Hospital. She stated that the entire process was very quick and convenient. This was also her first time seeking medical treatment in Shenzhen.
Miss Lo mentioned that she had done extensive research beforehand and felt confident because of the good reputation of the University of Hong Kong-Shenzhen Hospital, thus she did not have too many concerns about seeking treatment north.
After her first injection of the biologic drug, she started seeing signs of improvement in her skin within about three days; the symptoms of "weeping" had stopped, and her wounds healed quickly. “I used to have trouble sleeping, but now I can finally get a good night’s sleep, and my anxiety has significantly decreased.”
Compared to the price of over HKD 10,000 per injection in Hong Kong, Miss Lo pays about 3,000 RMB for each injection of the biologic drug in Shenzhen. For the same medication, the price is only one-third of the cost in Hong Kong, and she spends about 6,000 RMB per month on these injections, making her treatment affordable. Seeing this change in her condition has given her hope, significantly improving her quality of life: “Having been ill for so many years, I had stopped hoping and didn’t expect to be cured.”
Currently, Miss Lo travels to Shenzhen about every two weeks, mainly to receive her biologic injection at the hospital. “Actually, it’s very quick to take the high-speed train there; the entire injection process is also fast. I might arrive by 11:30 AM and be able to leave by noon.”
Cancer Targeted Therapies with Price Differences of Nearly Eight Times
The same pharmaceutical company and drug can often have price differences of several times between Hong Kong and mainland China. According to the Hong Kong Health Bureau, since Hong Kong and the mainland belong to two different tariff zones with their own customs regulations, it is not possible to participate in the mainland's unified drug procurement.
The issue of high-priced medications in mainland China has been prevalent for years, particularly since the release of the 2018 Chinese film "Dying to Survive," which reignited societal attention on the high costs of cancer drugs. Following this, the mainland negotiated with pharmaceutical companies through the National Healthcare Security Administration to include these drugs in the insurance drug catalog, prompting drug manufacturers to reduce prices.
Seventy-year-old Ms. Ying was diagnosed with stage four lung adenocarcinoma in 2022. In an interview with BBC Chinese, she stated that in the first year, she primarily used a first-generation targeted therapy drug that had already been included in Hong Kong's medication list, and therefore did not need to purchase high-cost self-paid drugs. However, after about a year of use, her body began to develop resistance, requiring her to switch to a third-generation targeted drug that required self-payment.
Switching medications means having to pay out of pocket, and Ms. Ying mentioned that a nine-month supply costs 350,000 HKD, which means about 38,000 HKD per month, and requires a one-time payment. Although patients in need can apply for assistance from private funds, they must undergo strict financial review. “At that time, I felt quite anxious. If it’s just a one-time payment of 350,000, then I would do my best to manage that. But if I have to go back in nine months, it feels like an endless pit—how many instances of 350,000 can I handle?”
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Later, Ms. Ying's daughter learned through a cancer information support network in Hong Kong that the same targeted medication could be purchased at a much cheaper price in Shenzhen. Thus, at the beginning of this year, she took her mother to the University of Hong Kong-Shenzhen Hospital to buy the medication. Currently, she needs to go to Shenzhen about once a month, at a cost of about 5,000 RMB, which is nearly eight times cheaper.
Upon discovering that this was an option for purchasing medication and that it was financially manageable, Ms. Ying felt more settled emotionally. Initially, she heard differing opinions, such as claims that the medications in Shenzhen were "sub-branded" drugs—medications replicated by other manufacturers after the original patent expired. “But at that time, I thought it wasn’t a big deal, after all, the price difference was tenfold.”
During a follow-up visit in Hong Kong, she inquired about the targeted drugs she purchased in Shenzhen with her Hong Kong doctors and pharmacists, who confirmed they were the same original brand medications. “I had to show the doctor the medication first, and when he said it was safe to take, I felt more confident using it.” The expensive medication is also a burden for her, and she hopes that drug prices can be reduced in Hong Kong in the future. “I’ve seen cancer patients in Hong Kong who have to sell their homes to afford medication—it’s truly a case of having money to have life.”
In an interview with BBC Chinese, the Dean of the School of Professional and Continuing Education at Hong Kong Polytechnic University, Dr. Run Bok-wan, stated that recently, besides "shopping north" and entertainment, more and more people are paying attention to "seeking medical treatment north." Besides the significant price differences for medications and surgeries between the two regions, the long waiting times in Hong Kong's public hospitals and insufficient dental services are also reasons attracting Hong Kong residents to seek medical care in mainland China.
Dr. Run explained that the price differences for medications between Hong Kong and mainland China are substantial primarily due to the different pricing strategies of pharmaceutical companies globally. “In particular, in higher-income countries, prices tend to be much higher, mainly to recoup research and development costs.”
He noted that in countries with larger populations and single buyers, bargaining power is generally higher. “For example, the National Healthcare Insurance in mainland China has significant bargaining power. If a drug is included in the reimbursement list, then it can be claimed by the healthcare insurance population nationwide, leading to widespread purchases. In this situation, the government can negotiate much lower prices from the pharmaceutical companies.” In contrast, as Hong Kong is a high-income region with a smaller population, “the bargaining power is not as strong, which explains the significant price differences in what the Hong Kong Hospital Authority can negotiate compared to Chinese medical insurance.”
Cross-Border Medical Services Become a Trend
Dr. Run mentioned that there has been a trend of Hong Kong residents seeking medical treatment in the Greater Bay Area, noting that “before the pandemic, most were going for dental services.” In recent years, the Hong Kong government has been actively promoting medical integration in the Greater Bay Area, expanding the use of elder care vouchers to designated hospitals and clinics in the Bay Area, and promoting the implementation of electronic cross-border health records and “Hong Kong-Macao drug and medical device access” policies.
In addition to traveling north to purchase "sky-high priced medications," many Hong Kong residents also go to Shenzhen for dental care, check-ups, and treatments. Before the pandemic, Fion had family experience with dental visits in Shenzhen, and after the travel restrictions were lifted, she planned to undergo orthodontic treatment. After comparing prices and services in both Hong Kong and Shenzhen, she saw a recommendation for one of the dental chain groups in Shenzhen on Xiaohongshu. “So, I went up for a consultation, and the price discussed afterward was acceptable to me.”
Fion indicated that the total cost for the orthodontic treatment was about 15,000 HKD, and it has been ongoing for over a year now. During this time, she also tried out a teeth-whitening service at this clinic for about 1,000 HKD. “I paid for that through Meituan; I found the pricing very transparent.” For Fion, she understands that some Hong Kong residents may have concerns about receiving dental treatment in Shenzhen, “but it really depends on your confidence; I don’t think Hong Kong is particularly better.”
On social media platform Xiaohongshu, users searching for terms like “seeking medical treatment north” and “seeing a doctor in Shenzhen” have shared their experiences and reasons for seeking medical care in Shenzhen, praising the quality of healthcare there. Most of their choices are for the University of Hong Kong-Shenzhen Hospital or top-tier hospitals in mainland China. However, there are also some comments from mainland Chinese netizens expressing sentiments such as: “I hope Hong Kong people don’t come to occupy mainland medical resources” and “there are still many Hong Kong residents who look down on the mainland and were unwilling to accept aid from mainland healthcare workers during the pandemic.”
On the other hand, in recent years, several cities in mainland China have seen the emergence of a new industry known as "medical companions." Their main services include accompanying patients for consultations, surgeries, and picking up medications and reports. Currently, there are also many medical companions in Shenzhen. A medical companion based in Shenzhen, Xiao Yu, told BBC Chinese that Hong Kong residents make up about one-fifth of her total clients. “Maybe one or two a week,” she said, but she believes that the potential demand in the future is substantial, as “there may still be many Hong Kong clients who are not aware of such services.”
Xiao Yu mentioned that Hong Kong clients usually choose the University of Hong Kong-Shenzhen Hospital, “but there are also many other top-tier hospitals where patients undergo examinations, including endoscopies and anesthesia procedures, since hospitals generally require someone to accompany them.” She noted that patients can typically receive their reports about half an hour after completing an examination, making the entire process very quick.
Dr. Lam Wing-ho, a family doctor in Hong Kong, mentioned in an interview with BBC Chinese that since the border reopening last year, he has noticed that some patients have been getting expensive procedures like check-ups and scans done in the Greater Bay Area and then bringing their reports to Hong Kong doctors for diagnosis and treatment. “Since the pandemic and the reopening, this situation has gradually increased.”
Dr. Lam Wing-ho pointed out that seeking relatively cheaper medical services across borders has historically existed, “For example, people used to go to Thailand and other places. The most important thing is that we hope the quality of the reports is good, and that the medications and tests are also of high quality. In the past, we had some concerns because we weren't very clear about simplified Chinese characters, which led some patients to decide to return to Hong Kong for further examination.”
Generally speaking, if a patient encounters a medical accident while seeking treatment in Hong Kong, they can file a complaint with the Hong Kong Medical Council and seek accountability. Related cases will go through legal and disciplinary hearings at the Council. However, if Hong Kong residents encounter medical disputes or accidents while seeking treatment in mainland China, they may find themselves in a situation where they have "nowhere to turn for help."
According to the Shenzhen Health Commission, if a medical accident occurs involving district-level medical institutions, one can consult the local health bureau for assistance; if it involves municipal-level or other relevant medical institutions, one can bring identification, medical records, and other relevant documents to apply to the Municipal Health Commission or the Shenzhen Medical Association.
Dr. Run Bok-wan stated that cross-border medical care is a global phenomenon. “Medical tourism is a huge industry, and many countries hope to develop this market, which is continuously expanding.” In the past, many residents from mainland China traveled to Hong Kong for treatment, but there has been a reversal in recent years. For the 700,000 people who sought medical services in Shenzhen last year, Dr. Run estimates that the actual demand may be even greater. “700,000 might be a conservative estimate; if you calculate purchases of medications, doctor visits, traditional Chinese medicine, health check-ups, and wellness services, it amounts to a significant number.” Dr. Run believes that if the medical situation in Hong Kong does not improve, it will lead more people to choose to "seek medical treatment north," stating that “this trend will continue.”