Characteristics of hospitalization patterns and expenditures in cross-border medical tourism: a knee replacement surgery cohort study

Objective Using knee arthroplasty as a case study, this research explores the characteristics of length of stay (LOS) and hospitalization costs for Hong Kong residents receiving medical treatment in mainland China. Methods Utilizing front-page medical record data of patients who underwent knee arthroplasty at Hospital H, descriptive statistics, univariate analysis, and mediation effect tests were conducted to analyze the impact of being a Hong Kong patient on LOS and hospitalization costs. Results The study included 356 patients, predominantly older adults over 65 years old (77.25%), with a similar gender distribution. Hong Kong patients had shorter LOS, shorter postoperative LOS, and lower hospitalization costs, laboratory and examination costs, and medication costs. LOS fully mediated the effect of being a Hong Kong patient on hospitalization costs. Conclusion Hong Kong residents seeking medical care in mainland China are driven by factors distinct from those of non-local patients within mainland China, with medical quality, efficiency, and cost being significant drivers of cross-border healthcare seeking. It is essential to strengthen cross-border medical collaboration between Shenzhen and Hong Kong, and the Greater Bay Area as a whole, through institutional mechanisms, welfare benefits, long-term follow-up, and health monitoring to ensure tangible medical benefits for Hong Kong patients.