Cross-border Childbirth Between Mainland China and Hong Kong: Social Pressures and Policy Outcomes

Bernard Yam


Abstract

Using secondary data analysis, this paper examines the societal impact of mainland Chinese expectant mothers who gave birth in Hong Kong (HK). In 2009, 45.4% of live births were born to this group of women, compared to 10.2% in 1995. These women agreed unanimously that giving birth in HK would secure the future of their child with permanent residency, access to free education, subsidised health care, social welfare benefits and a better standard of living. For parents who choose to have more than one child, cross-border birthing can provide an opportunity to bypass China’s one-child policy. This rising trend has put heavy pressure on the already stretched obstetric services at the expense of local women. The Hospital Authority (HA) responsible for public hospitals acknowledged that in the 2004-5 financial year, 1 670 mainland women failed to pay HK$12.64 million (USD1.63m) in hospital bills; and in 2005-6, 2 138 women defaulted HK$28.58m (USD3.68m). In response to protests at this situation and the lack of an effective policy, HA introduced an obstetric package in February 2007. Non-local expectant mothers must now pay HK$39 000 (USD5 000) in advance to cover one antenatal visit, delivery service and delivery-related hospitalisation for three days; non-compliant women would be charged HK$48 000 (USD6 154). Mainland women who are over 28 weeks’ gestation are now denied entry at immigration checkpoint if they do not have a prior booking. Between February and December 2007, an HA audit showed a 229% increase in booking for public hospitals alone and secured HK$257.4m (USD33m) in fees. Non-compliant cases and last-minute hospital admissions were significantly reduced. In addition to the high bill settlement rate, this policy has provided a steady workload and training opportunities for many health care providers. If these new citizens remain in HK, they may contribute to the prosperity as well as alleviating the ageing population of HK.

Keywords

China; Cross-border Childbirth; Hong Kong; Medical Tourism; Social Policy.

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References

Au Yeung, S. 2006, 'Impact of Non-Eligible Person Deliveries in Obstetric Service in Hong Kong, ' Hong Kong Journal of Gynaecology, Obstetrics & Midwifery, vol. 6, no. 1: 4144.

Boslaugh, S. 2007, Secondary Data Sources for Public Health: A Practical Guide. Cambridge University Press, Cambridge. http://dx.doi.org/10.1017/CBO9780511618802

Census and Statistics Department, Hong Kong Special Administrative Region 2002, Demographic Trends in Hong Kong 19812001. Online available: http://www.censtatd.gov.hk/products_and_services/products/publications/statistical_report/population_and_vital_events/index_cd_B112001701_dt_latest.jsp [Accessed 9 November 2010].

Census and Statistics Department, Hong Kong Special Administrative Region 2010, Hong Kong Population Projections 20102039. Online available: http://www.censtatd.gov.hk/products_and_services/products/publications/statistical_report/population_and_vital_events/index_cd_B112001504_dt_latest.jsp [Accessed 9 November 2010].

Cheng, M. 2007, 'Hong Kong Attempts to Reduce Influx of Pregnant Chinese, ' Lancet, vol. 369, no. 9566: 981982. http://dx.doi.org/10.1016/S0140-6736(07)60476-0

Cheng, P. 2007, Impact of Use of Obstetric Services by Mainland Women on Public Hospital Resources. 9 January. Online, available: http://www.legco.gov.hk/yr06-07/english/panels/hs/papers/hs0108cb2-833-1-e.pdf [Accessed 12 November 2010].

Department of Health, The Government of the Hong Kong Special Administrative Region 2008, Department of Health 2007/2008 Annual Report. Tables on Health Status and Health Services 2007. Online, available: http://www.dh.gov.hk/english/pub_rec/pub_rec_lpoi/pub_rec_lpoi_thshs_2007.html [Accessed 2 November 2010].

Government Information Centre 2007, Press Releases. New Measures on Obstetric Services and Immigration Control Announced. 16 January. Online, available: http://www.info.gov.hk/gia/general/200701/16/P200701160184.htm [Accessed 12 November 2010].

Hong Kong Yearbook 2008 2008, Online, available: http://www.yearbook.gov.hk/2008/en/index.html [Accessed 2 November 2010].

Hong Kong Yearbook 2010 2010, Online, available: http://www.yearbook.gov.hk/2010/en/index.html [Accessed 23 September 2011].

Hospital Authority 2010, Press Release. Two More Public Hospitals Awarded International Accreditation. 4 November. Online, available: http://www.ha.org.hk/haho/ho/pad/101104Eng.pdf [Accessed 15 November 2010].

Hospital Authority n. d., Fees and charges. Online, available: http://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10044 & Content_ID=10045 & Ver= HTML [Accessed 23 September 2011].

Legislative Council, HKSAR 2008a, Legislative Council Panel on Health Services. Review of the Obstetric Service Package Charge for Non-Eligible Persons. 18 February. Online, available: http://www.legco.gov.hk/yr07-08/english/panels/hs/papers/hs0218cb2-1050-3-e.pdf [Assessed 12 November 2010].

Legislative Council, HKSAR. 2008b, Press Releases. LCQ17: Babies Born in Hong Kong to Mainland Women. 9 April. Online, available: http://www.info.gov.hk/gia/general/200804/09/P200804090257.htm [Accessed 12 November 2010].

Lee, K. 2007, Motions: Non-Local Pregnant Women Giving Birth in Hong Kong. Online, available: http://www.leekoklong.org.hk/e_index.htm [Accessed 12 November 2010].

Leung, W. 2009, 'Social Obstetrics: Non-Local Expectant Mothers Delivering Babies in Hong Kong' Hong Kong Medical Diary, vol. 14, no. 3: 1314.

Moir, J. 1998, 'Illegal Immigrant Mothers at Risk from Lack of Check-ups.' South China Morning Post, 22 June: 3.

Stewart, D. W. & Kamins, M. A. 1993, Secondary Research: Information Sources and Methods. 2nd ed., Sage, Newbury Park.

Wong, W. n. d., Trent and JCI Hospital Accreditation. What For? And Why Both? Online, available: http://www.wongsworld.org/dad_web_presence/Trent%20and%20JCI%20hospital%20accreditation%20-%20What%20for%20and%20why%20both.pdf [Assessed 15 November 2010].

World Health Organization 1996, Perinatal Mortality: A Listing of Available Information. WHO, Geneva.

World Health Organization 2006, Neonatal and Perinatal Mortality: Country, Regional and Global Estimates. WHO, Geneva.

World Health Organization 2007, Neonatal and Perinatal Mortality: Country, Regional and Global Estimates 2004. WHO, Geneva.

World Health Organization 2010a, Trends in Maternal Mortality: 1990 to 2008. Estimates Developed by WHO, UNICEFF, UNFPA and the World Bank, WHO, Geneva.

World Health Organization 2010b, World Health Statistics 2010, WHO, Geneva.

Yam, B. & Au, S. 2004, 'Comparison of the Experiences of Having a Sick Baby in a Neonatal Intensive Care Unit Among Mothers With and Without the Right of Abode in Hong Kong, ' Journal of Clinical Nursing, vol. 13, no. 1: 118119. http://dx.doi.org/10.1046/j.1365-2702.2003.00843.x