Collaborative Health Governance in the Greater Bay Area in China: Institutional Frameworks and Lessons for European Integration

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), which operates under "One Country, Two Systems" with distinct healthcare systems across jurisdictions, 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 five principal challenges: conflicting governance paradigms, institutional quality disparities, innovation deficits, inter-jurisdictional competition, and critical data governance plus insurance 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 service models; 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; and systematically addressing financing fragmentation through joint pools and value-based payment.