Abstract
BACKGROUND: Patient satisfaction is a proxy indicator for evaluating the efficiency, equity and quality of healthcare provision. Recent years have seen increasing cross-boundary healthcare utilization worldwide along with enhanced population mobility amidst the globalization process, while empirical research on patients’ satisfaction with cross-boundary healthcare services is limited. This study aims to enrich the understanding of patient satisfaction with cross-boundary healthcare utilization, and provide policy implications for healthcare governance. METHODS: A cross-sectional study was conducted in 2023. A total of 3500 Hong Kong residents were sampled in Hong Kong, Guangzhou, and Shenzhen proportional to the age structure, among which 1208 had cross-boundary healthcare experiences in mainland China. The PSQ-18 (Patient Satisfaction Questionnaire-18), a standard validated questionnaire with seven subscales was used to measure patient satisfaction. Satisfaction/dissatisfaction with cross-boundary healthcare was differentiated according to whether a patient’s PSQ-18 score for mainland China’s healthcare services was higher or no higher than that for Hong Kong’s healthcare services. Binary logistic regression models were run to explore the associations between satisfaction/dissatisfaction and patients’ socio-demographic characteristics. RESULTS: Among respondents, 19.3% expressed higher “general satisfaction” with healthcare services in mainland China than that in Hong Kong. The “interpersonal manner” of cross-boundary healthcare received the highest rating (83%) while “financial aspects” scored the lowest (67%). Mainland China’s healthcare facilities performed better in “interpersonal manner” and “accessibility and convenience” compared to Hong Kong, but improvements were needed in other subscales. Patients’ socio-demographic characteristics such as age (AOR: 2.62, 95% CI: 1.66–4.13), gender (AOR: 0.71, 95% CI: 0.52–0.98), children (AOR: 1.76, 95% CI: 1.10–2.81), employment (AOR: 0.52, 95% CI: 0.34–0.80), or duration of stay in mainland China (AOR: 0.62, 95% CI: 0.42–0.91) were associated with general satisfaction with cross-boundary healthcare. Household income, mainland China’s media use frequency, and health status significantly influenced multiple dimensions of patient satisfaction (p < 0.05). Age emerged as the strongest predictor across all seven PSQ-18 dimensions. CONCLUSION: The level of patient satisfaction with cross-boundary healthcare and its influencing factors varies across different dimensions. Targeted interventions to promote cross-boundary healthcare utilization among Hong Kong residents should prioritize the elderly, males, employees, patients with dependent child(ren), and low-income groups. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14096-y.