A man wears a surgical mask in Hong Kong. The city's health business depends heavily on people living on the other side of the Shenzhen River. Jerome Favre / Bloomberg

With higher living standards and increases in income, it has become much easier for mainland residents to acquire quality medical services. Diego Laje and Eudora Wong report.

Orthodontist Dr Paul Lau, 50, says he has more mainland residents coming to Hong Kong to see him than ever before. "There is an obvious increase in mainland residents visiting our clinic," Lau said.

Lau, along with five full-time dentists and four part-timers, works at the Orthodontic Center in Central.

Lau says that mainland residents only make a modest contribution to the clinics revenue - for now. "About 5 percent of the patients in our clinic are from the mainland, but there has been an increase over the past two years," Lau said. However, other sectors of the city's local health business depend heavily on people living on the other side of the Shenzhen River.

With higher standards of living and increases in incomes, it has become much easier for mainland residents to acquire overseas medical help. But not all health care fields in Hong Kong have seen the same growth in their revenue as a consequence of this, as some fields are more attractive than others for prospective patients.

A number of factors go into the equation when mainland residents think about either their next new smile, a nip and tuck, or expanding the family.

The city's lure to these health tourists is based then on relatively more supply of medical practitioners as well as standards of quality.

"More mainland residents come to Hong Kong because private hospitals are not fully developed on the mainland, which means a short supply of medical and health care there," Lau said.

There are 11,727 registered medical practitioners in Hong Kong, with 13 private hospitals and 41 public hospitals and institutions along with other clinics, according to the Medical Council of Hong Kong. This means Hong Kong has 16.8 doctors per 10,000 inhabitants, whereas the rest of the country is at an average of 14, according to the World Health Organization.

While the mainland has a bigger supply of medical services, it is often difficult for many patients to know where they can receive treatment at international standards.

"The medical quality on the mainland may be similar to Hong Kong's, but there is no unified supervision of standards on the mainland, so Hong Kong seems to be a safer option," Dr Choi Kin, president of the Hong Kong Medical Association, said.

One lawyer, who specializes in medical malpractice cases, says that he is also aware that things can go wrong in this city, too. But strict laws, and their enforcement, foster a environment of credibility that also acts as solid marketing.

"Hong Kong's medical standards are better, they are international quality," Woody Cheung, of law firm Mayer Brown, said.

But for one plastic surgeon, there is also a close link between enforcement of standards and scientific debate.

"We discuss and do plenty of research before considering the use of any new technologies or materials, because sometimes you find materials that claim to be new, but they are just an unsuccessful product launched a few years ago with a different name," Dr Peter Pang explained.

Pang attributes the high level of quality to the work of the Medical Council of Hong Kong.

For him, the past year has seen a 10 percent increase in patients from the rest of the country. From his point of view, the increase in work provides a clear illustration of why more institutions such as the council are needed throughout all of China.

"Half of our mainland patients come to us to fix the low quality surgery they received on the mainland," Pang said.

While some of the plastic surgeons are very experienced on the mainland, some are not even registered, according to Pang.

Nevertheless, keeping up with the latest and safest standards is just about all the marketing local health professionals are allowed do.

Advertising medical services or businesses is not allowed anywhere for Hong Kong doctors, according to Pang.

Prospective patients on the mainland have only one way of knowing where to go for help. "(Mainland patients) come to doctors in Hong Kong through word of mouth," Yu Kai-man, spokesman for the Hong Kong College of Obstetricians and Gynaecologists, said.

In the case of obstetrics, the sector is enjoying a boom thanks to mainland mothers.

There has been an increase in the number of births to mainland women in the city - from 7,810 in 2001, to 37,253 in 2009 - according to the Census and Statistics Department.

Births and an inflow of mainland residents have become an important factor in the overall population increase, 0.9 percent in Hong Kong in 2010. "In Hong Kong, there were 80,000 babies born in public hospitals in 2010, and 44,000 of which were mainland babies, the percentage of mainland babies born in private hospitals was about 70 percent," Yu said.

The reasons why mainland women choose to give birth in the SAR are not only due to an insufficient supply of hospitals on the mainland, but also because of the one child policy.

Parents come to Hong Kong after their first baby, as "the one child policy is the main reason why mainland women choose to give birth in Hong Kong, they also get the right of abode in Hong Kong", said Dr Choi Kin.

And the arrival of new babies is also visible from a business point of view.

While the Hospital Authority doesn't compile revenue figures for the maternity department alone, revenue for public health centers in the city has gone from HK$1.6 billion ($206 million) in 2006 to HK$2.7 billion ($348 million) in 2010. Hospital revenue grew 68 percent while the total population in the city grew about 2 percent during the same period.

"The mainland residents now have more money, so most of the hospitals' major income is from pregnant mainland women," Choi added.

And Hong Kong has more perks for mothers and their newborn infants as the comfort level of their stay can be increased at a private hospital, Yu said. Of course, everything comes at a price.

"Mainland pregnant women need to find accommodation and they have other expenses to cover. Some told me it cost them over HK$100,000 ($12,800) to give birth in Hong Kong," Yu explained.

There are many reasons, including high quality medical services, why children are born outside of the mainland. But for the plastic surgery sector, competition in the region is fierce.

South Korea and Thailand are in fact the most popular locations for plastic surgery, according to Pang.

Nevertheless, around a third of his patients who come for plastic surgery are from the mainland. This is despite the fact that advertising isn't allowed and that the city's limited space prevents faster expansion.

"Although our prices are similar to other Asian countries, travel expenses, for example, hotels, are higher in Hong Kong - especially for the patients who need longer time to recover," Pang said.

Surgeons have considered bringing out plastic surgery packages that include travel and accommodation along with the surgery; however, as hotels with similar standards in other countries such as Thailand have significantly lower prices with more spacious rooms, the idea was abandoned, Pang said.

Dentistry is another sector that is still not that popular among medical tourists.

"I predict an increase of mainland patients in Hong Kong's dentistry business because the central government does not give full support to dental care on the mainalnd," Lau claimed. In addition, the high speed railway scheduled to open in 2016 will make it easier to travel between Hong Kong and the rest of China.

For the 2,126 registered dentists in Hong Kong, this is good news. But that is all the good news they will get.

Even though the number of mainland patients may be increasing, most of the treatment is not a one-time service, therefore patients often have to go back several times.

"Limited travel permits is one of the main reasons why the percentage of mainland patients is still low," Lau said.

In order for medical tourism to develop further, both Pang and Lau concede that the government's help is essential.

Lau says that both the Hong Kong and the central governments should work in close association, including issuing longer permits for mainland residents and providing more training for practitioners to handle an increase in patients.

Lau himself is also getting prepared for more mainland patients as "compared to two years ago, I have to talk to more mainland patients, so my Mandarin is getting better," he said.

(HK Edition 03/22/2011 page3)