Overview of the healthcare system in the nine Mainland cities in the Greater Bay Area 2 August 2019 With the completion of the Hong Kong-Zhuhai–Macao Bridge which further reduces the “One Hour Living Circle” distance within the Greater Bay Area, the flow of quality healthcare resources and advanced medical technology among the three regions can be more effective and efficient. The three regions have varying social backgrounds and healthcare systems; hence the hospitals among which are culturally different. Hong Kong and Macao have robust strength in their medical foundation, with internationally aligned medical systems and medicines, as well as market access systems for medical devices. However, the situation of an aging population is becoming increasingly profound. Meanwhile, Guangdong province has abundant resources for keeping medical case records and is showing a significant advantage in clinical research. It is also actively opening towards new technologies and seeking advancement in medical techniques. The Medical Consultation Process in the Mainland The healthcare system in the Mainland includes public and private hospitals, with the majority being public hospitals. Some of the public hospitals have dedicated clinics for non-Mainland patients. It is worthy to note that the medical system or service process between the Mainland and Hong Kong are quite different. Thus, Hong Kong residents need to seek for appropriate medical services based on their own personal needs and medical records before visiting the clinics / hospitals. Below is the general process for consultation in public hospitals. 1. Outpatient service Medicine Registration Subsequent Consultation Payment collection / * treatment Examination For common illnesses and minor health problems, Hong Kong residents may choose to visit outpatient services from nearby hospitals for treatment. Please refer to Appendix I for outpatient information on major hospitals in the nine Mainland cities in the GBA. The process of outpatient service generally includes the following steps: * outpatient examination fees should be paid at Registration The Guangdong government is gradually promoting the reservation system for medical consultation. Hong Kong residents may make an appointment for outpatient service before their arrival to avoid the long process of queuing. Reservation methods include online booking (such as through each hospital's website or WeChat, or through following "Guangdong cloud hospital" on Alipay or WeChat), telephone, and self-service booking (through self-serve machines on the out-patient floor). Since booking an appointment require real-name registration, Hong Kong residents are required to set up an account for their first-time registration, and provide identification documents such as their Home Return Permit. If they are unable to attend in person due to rescheduling conflicts, Hong Kong residents should rearrange their schedule or cancel their appointment. They may be blacklisted or unable to book future appointments if there are multiple no-shows. Mainland hospitals adopt the "Payment before consultation" approach. If Hong Kong residents require further examination or subsequent treatment after initial consultation, they should settle their payment for examination or treatment before heading to the examination or treatment room. The fees for outpatient services differ; for instance, outpatient examination fees in Guangzhou range between RMB 10 to RMB 80 depending on the doctor’s grade (including general practitioners, assistant chief physician, chief physician and medical consultant etc.) The fees for medical consultation and examination are collected separately, and the amount generally depends on the whether medication is required, whether the medication is covered under medical insurance, and dosage etc. 2. Emergency service Emergency departments in hospitals across the nine Mainland cities are generally open for 24 hours. In case of emergency, patients may visit the emergency departments by themselves for treatment. Otherwise, ambulance services are available through emergency hotline 120. Please note that rates apply and may vary depending on the travel distance and nature of the services etc. Hong Kong residents may seek for the medical services according to their own needs. 3. Hospitalization For patients suffering from serious illness that requires hospitalization for further treatment or surgery, outpatient doctors would issue an admission slip, diagnosis, examination checklists (if any) after assessing their condition. Patients should first settle part of their payment at the outpatient payment counter, then make a registration for hospitalization. This process would create an account for the patients, where the appointments for examination and hospitalization times would also be communicated to the relevant treatment departments. Medical Insurance 1. Basic medical insurance in the Mainland According to “Interim Measures for Hong Kong, Macao and Taiwan Residents to Join the Social Insurance Scheme in the Mainland (Draft for Comment)” issued in 2018, Hong Kong residents employed in the Mainland shall join the scheme for five types of basic social insurance. Non-employed Hong Kong citizens residing in the Mainland may join the Basic pension insurance for urban and rural residents and Basic medical insurance system for urban residents. The coverage of each insurance available to Hong Kong, Macao and Taiwan residents, and conditions and measures for enjoying insurance benefits, are identical to those for Mainland residents. If Hong Kong residents have joined the basic medical insurance scheme in the Mainland, they may use the social security card to pay the portion of the fee borne by the government when visiting Mainland hospitals, while the remainder shall be paid by the patient. Since convenience stores, health products and cosmetic stores and supermarkets in the Mainland are prohibited from selling drugs, Hong Kong residents should purchase prescribed drugs at designated medical institutions and retailing pharmacies, with the costs deducted directly from their social security cards. Information related to social security card and medical payment history may be found on the online service platform of the Human Resources and Social Security Department of Guangdong Province. (Website: http://ggfw.gdhrss.gov.cn/gdggfw/service/list.shtml) 2. Commercial insurance Most hospitals in the Mainland do not accept direct payment from foreign medical insurance cards. Hence if patients are required to use foreign medical insurance schemes in the Mainland, please ensure that the hospital or clinic is covered by the insurance scheme. If insurance claim is required, patients should retain the consultation invoice, obtain a certificate of diagnosis issued by the doctor and stamped by the integrated services medical counter at the outpatient hall. Preferential policies 1. Elderly Health Care Voucher With more transport links within the GBA, more Hong Kong elderly choose to reside in GBA cities upon retirement. The GBA is continuously exploring cross-border public services and social security. The University of Hong Kong-Shenzhen Hospital (“HKU- SZH”) is the first hospital to accept the Elderly Health Care Voucher at present. In fact, this scheme has already successfully piloted for three years, and has optimized the settlement information system and diagnosis service procedures from the use of such vouchers. Hong Kong residents who choose to pay with the Elderly Health Care Voucher for the services they have received for the designated medical service for the day should show their valid Hong Kong identity card or Certificate of Exemption issued by the Hong Kong Immigration Department at the designated cashiers, which are located at clinic center, 1st floor (outpatient) and B1 floor (emergency) of the HKU-SZH. 2. Medical benefits in the talent plan According to the “Implementation Measures for Talent Cards in Guangdong Province (for implementation)” issued in 2018 by the Guangdong provincial, Hong Kong citizens working in Guangdong province who fulfill certain conditions may apply for talent cards and enjoy the following medical services: A free health check arranged by the relevant talent authorities or employers per year; Priority in admission for designated hospitals in Guangdong province; Eligible spouses and children may join basic medical insurance and basic pension insurance schemes Conclusion The GBA continuously integrates the quality medical resources within the three regions. If Hong Kong residents fall sick in the Mainland, they may consider seeking medication from the nearest hospital. There are a multitude of medical institutions in the Mainland, with a myriad of medical cases, as well as advanced research on traditional Chinese medicine. Hence Hong Kong residents may benefit from shorter waiting times and hassle, and receive Chinese medical treatment if they seek for medical consultation in the Mainland. In addition, the relevant authorities are actively developing cross-border transfer services for non-emergency patients, and exploring the possibilities for cross- border referral cooperation with designated public hospitals for trial run. Under such arrangement, Hong Kong patients may be transferred by ambulances from Shenzhen hospitals and which would be picked up by Hong Kong ambulances at the Hong Kong port. Having said that, patients must seek doctor’s advice before returning to Hong Kong for treatment, and the patient's physical condition