One public, two health systems: Hong Kong and China, integration without convergence

Abstract

This paper will explore the political dimensions of public health between the Hong Kong Special Administrative Region (HKSAR) and China under the "one country, two systems" concept. Enshrined in the Basic Law which came into effect on 1 July 1997, it is the modus vivendi for Hong Kong's reintegration with the mainland ensuring that Hong Kong will retain its capitalist system and lifestyle, including its health care system for fifty years. In effect, it is the legal framework defining the relationship between the HKSAR (the city) and the Chinese state. In the past decade this modus vivendi has been challenged by cross-border public health crises with global impact such as HIV/AIDS, the newly emerging H5N1 ("bird flu") virus and SARS, as well as escalating crises in food safety of pork, fish, vegetables and other products imported from the mainland. The concentration here will be on south China, considering its human and ecological interdependence with Hong Kong. Other issues focus on divergent health care governance including financing and health care delivery as well as questions of equity or "right to health," all of which have precipitated a perceived need to re-evaluate the principle. Since the "one country, two systems" concept was originally formulated with Taiwan in mind, the Hong Kong experience will have a far-reaching impact on an important aspect in the future of the one-China policy of the People's Republic of China (PRC).