An infrastructural approach to cross-boundary healthcare access: The case of Hong Kong patients in the Greater Bay Area, China.

Cross-boundary healthcare travel has become increasingly important owing to accelerated population mobility and booming international healthcare markets. While prior research has examined why patients seek healthcare abroad, less is known about how their access is enabled and challenged in practice. To fill this gap, this paper introduces an infrastructural approach, which accounts for the interactions among various infrastructural actors and their power dynamics embedded in the broader market-state-social relationships. It examines how accessibility and inequalities are (re)produced and governed based on the study of Hong Kong residents' cross-boundary healthcare access in the Greater Bay Area. Drawing on interviews with 140 Hong Kong residents, 47 health professionals, and 20 government officials, our study reveals that cross-boundary healthcare access is shaped by the operations and interactions of four groups of infrastructural actors - business, regulatory, technical, and social - across six major healthcare procedures. Multiple power dynamics among these infrastructural actors and between them and patients result in constrained and unequal cross-boundary healthcare accessibility. These power dynamics are further embedded within the market-state-social relationships negotiated by the market-dominance and state-coordination governance dynamics in different periods. This relational and processual infrastructural approach offers a fuller understanding of how patients access cross-boundary healthcare services and the embeddedness and contextual specificity of cross-boundary healthcare. It also provides a methodologically effective tool to systematically study healthcare access in other contexts.