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Explaining medical disputes in Chinese public hospitals: the doctor–patient relationship and its implications for health policy reforms

  • Alex Jingwei He (a1) and Jiwei Qian (a2)
Abstract
Abstract

In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor–patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor–patient relationship is no less important than other institutional aspects of health care reform.

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Corresponding author
*Correspondence to: Jiwei Qian, East Asian Institute, National University of Singapore, 469A Bukit Timah Road, Singapore. Email: jiwei.qian@nus.edu.sg
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N.Aoki , K.Uda , S.Ohta , T.Kiuchi and T.Fukui (2008), ‘Impact of miscommunication in the medical dispute cases in Japan’, International Journal for Quality in Health Care, 20(5): 358362.

H. B.Beckman , K. M.Markakis , A. L.Suchman and R. M.Frankel (1994), ‘The Doctor-patient relationship and malpractice: lessons from plaintiff depositions’, Archives of Internal Medicine, 154(12): 13651370.

M.Bismark , E.Dauer , R.Paterson and D.Studdert (2006), ‘Accountability sought by patients following adverse events from medical care: the New Zealand experience’, Canadian Medical Association Journal, 175(8): 889894.

L. A.Conboy , E.Macklin , J.Kelley , E.Kokkotou , A.Lembo and T.Kaptchuk (2010), ‘Which patients improve: characteristics increasing sensitivity to a supportive patient-practitioner relationship’, Social Science and Medicine, 70(3): 479484.

V. S.Fan , M.Burman , M. B.McDonell and S. D.Fihn (2005), ‘Continuity and other determinants of patient satisfaction with primary care’, Journal of General Internal Medicine, 20(3): 226233.

P.Franks , A. F.Jerant , K.Fiscella , C. G.Shields , D. J.Tancredi and R. M.Epstein (2006), ‘Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators’, Social Science and Medicine, 62(2): 422432.

J.Gao , S.Tang , R.Tolhurst and K.Rao (2001), ‘Changing access to health services in urban China: implications for equity’, Health Policy and Planning, 16(3): 302312.

E.Gu and J.Zhang (2006), ‘Health care regime change in urban China: unmanaged marketization and reluctant privatization’, Pacific Affairs, 79(1): 4971.

D. M.Harris and C. C.Wu (2005), ‘Medical malpractice in the People’s Republic of China: the 2002 regulation on the handling of medical accidents’, Journal of Law, Medicine and Ethics, 33(3): 456477.

J. A.He (2014), ‘The doctor-patient relationship, defensive medicine and overprescription in Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen City’, Social Science and Medicine, 123: 6471.

L. D.Hermer and H.Brody (2010), ‘Defensive medicine: cost containment and reform’, Journal of General Internal Medicine, 25(5): 470473.

G. B.Hickson , E. W.Clayton , P. B.Githens and F. A.Sloan (1992), ‘Factors that prompted families to file medical malpractice claims following perinatal injuries’, Journal of American Medical Association, 267(10): 13591363.

W. C.Hsiao (1995), ‘The Chinese health care system: lessons for other nations’, Social Science and Medicine, 41(8): 10471055.

W. C.Hsiao (2008), ‘When incentives and professionalism collide’, Health Affairs, 27(4): 949951.

T. W.Hu , M.Ong , Z. H.Lin and E.Li (1999), ‘The effects of economic reform on health insurance and the financial burden for urban workers in China’, Health Economics, 8(4): 309321.

R.Kaba and P.Sooriakumaran (2007), ‘The evolution of the doctor-patient relationship’’, International Journal of Surgery, 5(1): 5765.

D. P.Kessler , N.Summerton and J. R.Graham (2006), ‘Effects of the medical liability system in Australia, the UK and the USA’, The Lancet, 368(9531): 240246.

S. S.Kim , S.Kaplowitz and M. V.Johnston (2004), ‘The effects of physician empathy on patient satisfaction and compliance’, Evaluation and the Health Professions, 27(3): 237251.

The Lancet (2010), ‘Chinese doctors are under threat’ (editorial)’, The Lancet, 376(9742): 657.

The Lancet (2014), ‘Violence against doctors: why China? Why now? What next?’(editorial)’, The Lancet, 383(9922): 1013.

Y. YLee and J. L.Lin (2010), ‘Do patient autonomy preference matter? linking patient-centered care to patient-physician relationships and health outcomes’, Social Science and Medicine, 71(10): 18111818.

W.Levinson , D. L.Roter , J. P.Mullooly , V. T.Dull and R. M.Frankel (1997), ‘Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons’, Journal of American Medical Association, 277(7): 553559.

H.Li , X.Wu , T.Sun , L.Li , X.Zhao , X.Liu , L.Gao , Q.Sun , Z.Zhang and L.Fan (2014), ‘Claims, liabilities, injuries and compensation payments of medical malpractice litigation cases in China from 1998 to 2011’, BMC Health Services Research, 14(390): 19.

X.Liu , Y.Liu and N.Chen (2000), ‘The Chinese experience of hospital price regulation’, Health Policy and Planning, 15(2): 157163.

M. J.Sewitch , et al. (2003), ‘Patient nonadherence to medication in inflammatory bowel disease’, American Journal of Gastroenterology, 98(7): 15351544.

D. M.Studdert , M. M.Mello , A. A.Gawande , T. K.Gandhi , A.Kachalia , C.Yoon , A. L.Puopolo and T. A.Brennan (2006), ‘Claims, errors, and compensation payments in medical malpractice litigation’, New England Journal of Medicine, 354: 20242033.

N.Summerton (1995), ‘Positive and negative factors in defensive medicine: a questionnaire study of general practitioners’, The British Medical Journal, 310: 2729.

U. F.Trummer , U. O.Mueller , P.Nowak , T.Stidl and J. M.Pelikan (2006), ‘Does physician-patient communication that aims at empowering patients improve clinical outcome?’, Patient Education and Counseling, 61(2): 299306.

S.Vick and A.Scott (1998), ‘Agency in health care: examining patients’ preferences for attributes of the doctor-patient relationship’, Journal of Health Economics, 17(5): 587605.

W. B.Weeks , T.Foster , A. E.Wallace and E.Stalhandske (2001), ‘Tort claims analysis in the Veterans Health Administration for quality improvement’, Journal of Law, Medicine and Ethics, 29(3/4): 335345.

H.Wu , Y.Zhao , J.Wang and L.Wang (2010), ‘Factors associated with occupational stress among Chinese doctors: a cross-sectional survey’, International Archives of Occupational and Environmental Health, 83(2): 155164.

H.Wu , L.Liu , Y.Wang , F.Gao , X.Zhao and L.Wang (2013), ‘Factors associated with burnout among Chinese hospital doctors: a cross-sectional study’, BMC Public Health, 13(786): 18.

D.Xu , et al. (2010), ‘Reformation of medical education in China’, The Lancet, 375(9725): 15021504.

Y.Zhang and X.Feng (2011), ‘The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study’, BMC Health Services Research, 11(235): 113.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
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