Organising cross-border care after arrival: receiving-system challenges in a China–Vietnam border region

Abstract

Cross-border healthcare is increasingly visible in border regions where patient mobility develops faster than the institutional arrangements needed to support care. Existing research has often examined why patients seek care abroad, while less is known about how receiving health systems organise care after cross-border patients enter local hospitals. This study examined the receiving-system challenges faced by Guangxi, China, in responding to cross-border healthcare demand from Vietnamese patients. A qualitative study was conducted in Guangxi using semi-structured interviews with 35 participants, including 6 policymakers, 9 hospital administrators, 11 healthcare providers, and 9 Vietnamese patients. Participants were recruited through purposive sampling. Data were collected between March 2024 and May 2025. Interviews were conducted in Chinese, with Vietnamese-Chinese interpretation provided when needed for Vietnamese patients. Data were analysed using thematic analysis. Six interrelated receiving-system challenges were identified across the pre-treatment, treatment, and post-treatment stages of care: pre-arrival preparation and hospital admission coordination, patient-authorized clinical documentation transfer and verification, language mediation and culturally responsive communication, patient-and-family navigation and inpatient support, billing documentation and claim-support navigation, and structured post-discharge follow-up after return to Vietnam. These challenges show that receiving cross-border patients requires practical arrangements that connect admission preparation, usable clinical information, communication, family involvement, payment documentation, and follow-up into a coherent care process. Cross-border healthcare in the Guangxi-Vietnam border setting should be understood as a receiving-system coordination challenge. For border-region health systems where formal cross-border arrangements remain limited, strengthening receiving-system readiness may help make care safer, more understandable, and more continuous for patients whose treatment trajectories cross national boundaries.