Abstract
Background: Cross-border health governance represents a critical challenge for integrated healthcare systems, particularly in regions with institutional diversity.
Objective: We analyzed collaborative health governance challenges and implementation strategies in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), operating under "One Country, Two Systems" with distinct healthcare systems, to derive lessons for European integration.
Methods: We employed comprehensive policy analysis examining governance paradigms, institutional frameworks, and collaborative mechanisms, synthesizing health governance theory, international comparative evidence, and regional policy documents to identify implementation challenges and evidence-based solutions.
Results: The GBA faces three principal challenges: conflicting governance paradigms, institutional constraints and regulatory barriers, and data governance and financial portability barriers. Successful collaborative mechanisms require: multi-level governance architecture with clear authority distribution; health information exchange platforms enabling interoperability and value-based payment; medical consortia with tiered care systems and integrated financing; systematic talent cultivation through joint training and licensing reciprocity; cross-border emergency coordination; and robust performance monitoring with equity-focused evaluation.
Conclusions: The GBA demonstrates that successful cross-regional health governance requires strategic embedding of administrative, market, and social mechanisms within supportive institutional frameworks emphasizing interoperability over standardization. Key lessons for European integration include: leveraging institutional diversity as innovation catalyst rather than harmonization prerequisite; implementing phased infrastructure deployment beginning with high-priority use cases; establishing clear multi-level authority delineation; prioritizing professional mobility through joint training programs; and systematically addressing financing fragmentation through joint risk pools and value-based payment.