Posted on Mar 31, 2011 by Sergio Ulloa
Hong Kong, this week, has again raised the issue of so-called "maternity tourists," and is questioning how to best fix the strain that an influx of Chinese mothers seeking to give birth in the city is placing on the SAR's healthcare system. Following hot on the heels of the announced closure of a Maternity House
in San Gabriel California, Hong Kong authorities are looking for options which would allow them to further control the flow of pregnant PRC nationals into the city.
Recent figures from the Hong Kong Hospital Authority
and Department of Health have revealed that mainland mothers accounted for approximately 40,000 births in Hong Kong during 2010; roughly 46% of the city's 88,000 total. This is a massive increase from the "few hundred" births from 2004 - 2005, and is set to rise even further in 2011 and again in 2012, with healthcare officials projecting the numbers at 92,000 and 100,000 respectively.
In 2007 the Hong Kong government introduced legislation which prevents women past the 28th
week of pregnancy from entering the city without providing proof of a booking at a local hospital. In addition to this, the government later introduced mandatory pricing for non-resident mothers seeking to give birth in one of the city's public hospitals; and while these initiatives were initially successful at stemming the tide, China's recent, and explosive, economic success has again seen the numbers move upwards.
For Chinese nationals there are a number of reasons for giving birth outside of the People's Republic, not in the least of which is the country's notorious "One Child Policy." The legislation severely penalizes families who have more than one child, and in the case of Guangzhou the fines associated with having a second baby can be as much as RMB 180,000 (US$ 27,450). In order to avoid the fines, while still being able to have a second, or even third child, many mainland parents are simply choosing to travel abroad to give birth.
However, while laying the blame at the feet of the "One Child Policy" may be conveniently easy, there are a number of more in-depth social factors which may be playing a role in the rapid development of the Chinese Maternity Tourism trend. One of these is to do with the way that the PRC's education system is structured.
In China, as elsewhere around the world, there is high concern from many parents regarding their child's education. Due to the way in which the PRC's school system is set up, if the child has a Chinese passport and/or residency in certain districts or states, the standards they need to reach in order to access the top schools is prohibitively high - they will need to score extremely well on both the middle and high school entrance exams. It is important to bear in mind the fact that China has a population of approximately 1.3 billion people, and as such competition for the best schools in the country is extremely stiff.
However, one of the major loopholes to this system is through the child possessing a foreign passport, or official residency outside of China, in this case Hong Kong. If the child is not a Chinese passport holder, and does not have official residency in China, then the standards of entry into the country's most prestigious educational facilities are dramatically lowered. In this case the child is treated as an "international" student, rather than a local one; although the family must pay the high fees associated with this status. In fact, some Chinese families have gone on record saying that they will raise their infant in China until the child reaches high school age, and then send them to Hong Kong to continue their education.
Outside of the Hong Kong healthcare system, the potential strain on the city's educational services is highly concerning. As with healthcare, Hong Kong has a public education system through which the children all permanent residents are allowed to receive their schooling. While competition for places at Hong Kong schools may be less stiff than across the border, the city has been experiencing severe issues with increasing class sizes and a lack of spaces for secondary students.
One option then is that the Chinese maternity tourists will send their children to private educational institutions within the city, and when looking at the costs involved with a non-resident mother giving birth within Hong Kong, this may not present as much of a significant financial challenge as one may think.
According to one recent interviewee, the Chinese husband of a PRC Maternity Tourist, he paid HK$ 80,000 (US$ 10,272) for a C-Section maternity package at a private hospital in Hong Kong. The package included antenatal medical checkups in the city. The source is quoted as saying that, even were the HKSAR government to impose further restrictions on public hospitals within the city, this would not pose a problem at private maternity hospitals, such as the Matilda, Sanatorium, or Baptist; primarily due to the fact that local Hong Kong mothers vastly prefer the services offered through the low-cost public system.
The increased preference of Maternity Tourists for the city's exceptional private medical facilities has highlighted an alarming issue with the Hong Kong medical community. Currently the Hong Kong Public Healthcare system is experiencing an alarming shortfall of qualified medical professionals, with many moving from public facilities to private institutions. This has left the city's public medical community severely short staffed, to such an extent that there have been calls to allow overseas medical practitioners, who have not passed the Hong Kong medical exam, to practice within Hong Kong public hospitals.
Additionally, the flood of doctors away from the public system has emphasized a serious supply concern; as private medical facilities receive more bookings, and expand ever further, the costs associated with treatment are likely to increase. This does not bode well for a city whose private medical costs are tied with Israel for being the second highest, on average, in the world; the USA is, of course, the most expensive place to receive healthcare treatment on earth.
Outside of medical pricing, there are additional problems posed by the Hong Kong public medical sector's "brain drain;" namely that, public hospitals within the city are vastly more prepared to handle any complications arising from a pregnancy. For example, Prince of Wales hospital, one of the city's most well regarded public healthcare facilities, in the last two years lost more than 10 senior doctors (including obstetricians) to the private sector. Prince of Wales hospital is also one of the few hospitals in the city which is able to offer comprehensive intensive care to newborns in the event of a complication of pregnancy, which will occur in roughly 2 out of every 100 births in Hong Kong.
The move of qualified medical practitioners away from the hospital means that, given enough time, such facilities may simply not be able to handle the treatment associated with complications of pregnancy, and will not be able to offer local mothers the treatment which has long been promised to them.
Hong Kong's close proximity to China has seen the city bear the brunt of the Birth, or Maternity Tourism trend for most of the phenomenon's existence. However, as recent events, such as the closure of the San Gabriel "Maternity House," show, mere proximity is not the underlying cause, and distance will not ensure protection. While local policy makers are stating that a flat ban on maternity tourists would be unacceptable, they are asking how the situation can be resolved.
Dr York Chow, Hong Kong's Secretary for Food and Health, has said that he is keen to liaise with both the public and private sectors to improve the outlook for healthcare in Hong Kong. However, the Private Hospitals Association president, Dr Alan Lau, has said of any potential legislation or reforms, "we are willing to discuss the matter and strive for good quality of care ... but any drastic measures contradicting the free market would be regrettable. The government would need good justification to limit our maternity beds."
As such, it is highly likely that yet another mandatory rate increase on non-resident mothers giving birth in Hong Kong public hospitals is on the cards. Local mothers can expect the government to act in their interests and protect public healthcare services, and the accessibility of those services to pregnant residents. While any legislation would potentially avoid instituting stringent requirements on Hong Kong private hospitals, due to the city's commitment to free-market principals and standing as the world's freest economy, simple supply vs. demand suggests that medical inflation within HKSAR is not set to decrease any time soon. With the growing demand for private hospitals and private medical services, the sector could see a record pay day and increased costs at the expense of HK residents, in favor of mainland mothers who are prepared to pay for the best services available.