Collaborative Health Governance in the Greater Bay Area in China: Institutional Frameworks and Lessons for European Integration Collaborative Health Governance in the Greater Bay Area
Main Article Content
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.
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References
2. WHO Europe. Building cross-border collaboration in health. 2024.
3. European Court of Auditors. EU actions for cross-border healthcare: significant ambitions but improved management required. Special Report No. 07. Luxembourg: Publications Office; 2019.
4. Guangdong-Hong Kong-Macao Greater Bay Area - Overview. 2024. Available from: https://www.bayarea.gov.hk/en/about/overview.html
5. European Union. Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. Off J Eur Union. 2011;L88:45-65.
6. Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394 (10204):1192-1204.
7. Li Q, Liu G, Zang W. The health of left-behind children in rural China. China Economic Review. 2015;36:367-376.
8. European Commission. European Reference Networks. 2023. Available from: https://health.ec.europa.eu/european-reference-networks
9. van der Zanden BAM, Hoebe CJPA, Horstman K. European policies for public health in border regions: no European mindset as yet. BMC Public Health. 2024;24:746.
10. WHO Europe. Report of the WHO subregional workshop on border/boundary health and cross-border/boundary collaboration. 2024.
11. Ye Y, Li Q. Unanticipated benefits: Left-behind peers and improved health in rural Chinese classrooms. Applied Economics Letters. 2024;31 (20):1915-1920.
12. Li Q, An L, Xu J, Baliamoune-Lutz M. Corruption costs lives: Evidence from a cross-country study. European Journal of Health Economics. 2018;19(1):153-165.
13. Li Q, An L. Corruption takes away happiness: Evidence from a cross-country study. Journal of Happiness Studies. 2020;21(2):485-504.
14. WHO Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization; 2008.
15. Ostrom E. Governing the Commons: The Evolution of Institutions for Collective Action. Cambridge: Cambridge University Press; 1990.
16. Li Q, Loh CA, Ye Y. Shushing the press shortens lives: Cross-national evidence of the impact of press freedom on life expectancy. Scandinavian Journal of Public Health. 2024; 52(7):1101-1111.
17. Ferlie E, McGivern G, Fitzgerald L. A new mode of organizing in health care? Governmentality and managed networks in cancer services in England. Soc Sci Med. 2012;74(3):340-347.
18. Exley J, Glover R, Manacorda T, et al. Governing integrated health and social care: an analysis of experiences in three European countries. Int J Integr Care. 2024;24(1):9.
19. Reibling N, Rosenthal MB. Why should stakeholders consider the effect of tensions in collaborative innovation in healthcare—lessons learned from surveying integrated care projects in Germany. BMC Health Serv Res. 2023;23:1255.
20. Li Q, An L, Zhang R. Corruption drives brain drain: Cross-country evidence from machine learning. Economic Modelling. 2023;126:106379.
21. Ye Y, He Q, Li Q, An L. The brother's penalty: Son preference and girls' health in rural China. Health Economics. 2024;33(8):1748-1771.
22. Struijs JN, Baan CA. Integrating care through bundled payments—lessons from the Netherlands. N Engl J Med. 2011;364(11):990-991.
23. Ricciardi W, Pita Barros P, Bourek A, et al. How to govern the digital transformation of health services. Eur J Public Health. 2019;29(Suppl 3):7-12.
24. Heenan D, Birrell D. The Integration of Health and Social Care in Scotland. J Integr Care. 2018; 26(3):163-174.