More Hong Kong doctors may well be heading to the mainland if plans to develop better health care services in the "Greater Bay Area" take off.
Pioneers who have already made the move to Guangdong in recent years say the prospects are exciting, and city doctors will gain not only from business opportunities, but also knowledge and experience if they get to treat a much larger pool of patients there.
Ophthalmologist Dr Dennis Lam Shun-chiu, who openedhis first mainland eye hospital in Shenzhen in 2013, said there was great demand for quality services across the border, including from Hong Kong retirees living there.
"They would be interested in health care services provided by Hongkongers," he said.
The greater demand for Hong Kong care could also lead to an enlargement of capacity in the city itself, added Lam, who has hospitals in Beijing and Kunming too. It might even provide the impetus to open a third medical school in the city, he said.
However, others warn Hong Kong's manpower-starved public health sector faces further strain under an even greater number of patients.
Finance minister Paul Chan Mo-po will today unveil his 2019-2020 budget, and all eyes will be on whether he dishes out more resources for struggling medical professionals, to help prevent any possible brain drain.
But doctors in private practice say there are important unresolved issues stopping more doctors from working over the border, ranging from insurance coverage to the availability of medicines.
"We are not familiar with the regulations involved in opening a clinic on the mainland," said Dr Ho Chun-ping, president of the Hong Kong Medical Association, which represents more than 10,000 doctors.
For now, he does not think many private practitioners will be keen to move.
The recently unveiled blueprint for the development of the Greater Bay Area, which will bring together Hong Kong, Macau and nine other Pearl River Delta cities, calls for closer cooperation in health care services.
It sees medical service providers from Hong Kong and Macau setting up facilities in the nine mainland cities, and encourages health care professionals from the two special administrative regions to cross the border for academic exchanges and short-term private practice.
It also says authorities will look into transferring non-emergency and non-critically ill patients across the border and explore a pilot scheme to refer patients between designated public hospitals on either side.
The blueprint does not spell out which patients stand to benefit, but Hong Kong Chief Executive Carrie Lam Cheng Yuet-ngor has said it will be only Hongkongers.
The Food and Health Bureau has said the main purpose is to help Hongkongers living in Guangdong province to return for treatment or recuperation.
According to the Census and Statistics Department, more than 525,000 Hongkongers were living in Guangdong at the end of 2017. They included more than 79,000 people aged 65 or older, as well as those working there and Hong Kong children born to mainland parents.
The Greater Bay Area spans 56,000 sq km and has a population of about 70 million. Beijing envisions turning it into a global innovation and financial powerhouse to rival Silicon Valley and Japan's Tokyo Bay area.
However, the health care services proposals come at a time when Hong Kong is facing a medical manpower shortage and frontline doctors in overburdened public hospitals are concerned about the impact.
The city has more than 14,000 doctors, about 40 per cent of them work in public hospitals, which provide more than 90 per cent of all inpatient care.
Dr Alfred Wong Yam-hong, a spokesman for doctors' concern group M\u00e9decins Inspir\u00e9s, is worried more patients will turn up at public hospitals if non-emergency patients from the mainland are transferred to Hong Kong hospitals.
He works at Tuen Mun Hospital, near the mainland border, and said even now, it was not uncommon to see Hongkongers living on the mainland crossing the border for medical treatment. Many have serious illnesses.
"More patients can be expected if non-critically ill ones are sent in too," he said. "The burden on public hospitals all over Hong Kong would increase."
For now, doctors in private practice appear lukewarm to the Greater Bay Area plans because of the different medical system in place on the mainland, as well as barriers to crossing the border to work.
The Medical Association's Ho said there were day-to-day issues too, including the fact medicines prescribed in Hong Kong might not be available across the border due to different regimes for introducing drugs.
"It will be troublesome if a doctor cannot prescribe a medication he has previously been using for patients," Ho said.
Mainland health authorities had told him they were looking into this matter.
Ho said medical insurance protecting against lawsuits and negligence claims was also an issue, because the professional indemnity scheme used by many doctors in Hong Kong did not cover the mainland.
The plans outlined in the Greater Bay Area blueprint are not the first initiative to encourage Hong Kong doctors to work on the mainland.
Under the Closer Economic Partnership Arrangement (Cepa), signed between the governments of Hong Kong and the mainland more than a decade ago, local doctors without mainland qualifications can work for up to three years over the border with a renewable licence.
The arrangement also allows Hong Kong health care providers to open medical facilities such as hospitals on the mainland through wholly owned, joint equity or contractual joint ventures.
As of the end of last month however, only 49 certificates had been issued under Cepa to local service suppliers to provide medical or dental services across the border.
Medical sector lawmaker Dr Pierre Chan said the relatively small number of doctors working on the mainland suggested there would not be a rush north even with the bay area plan.
However, doctors with experience there point to a number of advantages, not least having access to more patients with a wider variety of conditions than those seen in Hong Kong.
Doctors Union president Dr Henry Yeung Chiu-fat, a paediatrician in private practice, referred to visits he and other doctors had made to patients on the mainland.
"Some of the cases we saw in Guangdong province were cases none of us had seen before," he said. Recalling patients with Marfan syndrome, a genetic disorder that results in elongated arms, legs and fingers and heart problems, he said it was helpful to deal with such cases.
"Doctors are able to widen their knowledge, and will be able to identify a patient's condition more quickly," he said.
Yeung, who obtained a qualification to practise on the mainland in 2009, said his union was opening a clinic later this year in Guangzhou's Nanfang Hospital, a public facility with more than 2,000 beds, and Hong Kong doctors would provide short-term services there.
More than 20 private practitioners, including paediatricians and ophthalmologists, have signed up to work at the clinic on an appointment basis, and the union has obtained medical insurance to cover them.
It is in talks with mainland officials on whether the doctors will be able to prescribe drugs not yet available across the border.
Thoracic surgeon Dr Alan Sihoe Dart-loon is equally convinced that working on the mainland will give Hong Kong doctors an opportunity to improve their skills.
He has been performing operations at Shanghai Pulmonary Hospital since 2013 and helped develop thoracic surgery services at the University of Hong Kong-Shenzhen Hospital over the past five years. "If you have the numbers, you can advance and make progress in the medicine you practise," he said.
To give an idea of the difference in scale on either side of the border, he said a major Hong Kong public hospital carried out about 200 lung cancer operations a year, whereas Shanghai Pulmonary Hospital did 15,000.
"By treating mainland patients, we can learn and develop techniques which could then benefit Hong Kong patients as well," he said.
What remains to be seen is how patients would respond if the Greater Bay Area plans became reality.
Hongkonger Tam Kwok-yuen, a 76-year-old retiree who moved to Guangzhou about five years ago, said having more Hong Kong health care professionals practising on the mainland would benefit him only if he could use their services on a subsidised basis.
Currently, Hongkongers aged 65 or above are entitled to annual vouchers worth HK$2,000 for private health care services, including visits to general practitioners or dentists.
Tam said the Hong Kong government could allow seniors to use the vouchers at mainland health care institutions too. At present, they can do so only at the University of Hong Kong-Shenzhen Hospital.
A diabetes patient, he spends about 10 days each month in Hong Kong, and goes to a public hospital there every three months to undergo regular check-ups and collect his medicines.
"If there were more Hong Kong doctors on the mainland, but I could not enjoy any medical benefits, why would I see them?" he asked.
In 2011, Hong Kong and Shenzhen launched a pilot scheme for Hongkongers admitted to two public hospitals in Shenzhen.
Once their condition was stable, they could be transferred to two Hong Kong hospitals close to the border, namely Tuen Mun Hospital and North District Hospital, if they wished to move.
So far, however, only three patients have been sent to the Hong Kong hospitals under this arrangement.
A Hospital Authority source said this was because of conditions stipulating patients had to be admitted to one of two designated hospitals in Shenzhen, and could be moved only to the two in Hong Kong.
It may be early days yet, but a patients' advocacy group in Hong Kong is concerned about the impact on the city's stressed health care system if doctors have more choices of where to work.
"They might move elsewhere, or practise on both sides of the border, but end up spending less time in Hong Kong," said Alex Lam Chi-yau, chairman of Hong Kong Patients' Voices.
Even if private doctors are the ones drawn there, the group is worried more public sector practitioners will then be lured to fill gaps in the private sector.
An integration plan without measures to protect Hong-kongers' interests risked further diluting resources available for Hong Kong patients, especially those in the public sector, he said.
Lam suggested authorities consider transferring Hong Kong patients who need long-term rehabilitation care to facilities on the mainland, where space was more readily available.
"We need to look at give-and-take in this Greater Bay Area plan," he said. "If we are only giving without receiving anything, I can't see a future."
Financial Secretary Paul Chan Mo-po today delivers his third budget for Hong Kong. All eyes are on whether he will give more aid to the public health care sector to help prevent a possible brain drain to the mainland. In the last of a three-part series, Elizabeth Cheung examines city fears over losing its doctors amid plans to link health care services in the "Greater Bay Area"
