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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)

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.

Corresponding author
*Correspondence to: Jiwei Qian, East Asian Institute, National University of Singapore, 469A Bukit Timah Road, Singapore. Email:
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Adwok, J. and Kearns, E. H. (2013), ‘Defensive medicine: effect on cost, quality and access to health care’, Journal of Biology, Agriculture and Healthcare, 3(6): 2935.
Aoki, N., Uda, K., Ohta, S., Kiuchi, T. and Fukui, T. (2008), ‘Impact of miscommunication in the medical dispute cases in Japan’, International Journal for Quality in Health Care, 20(5): 358362.
Beckman, H. B., Markakis, K. M., Suchman, A. L. and Frankel, R. M. (1994), ‘The Doctor-patient relationship and malpractice: lessons from plaintiff depositions’, Archives of Internal Medicine, 154(12): 13651370.
Bismark, M., Dauer, E., Paterson, R. and Studdert, D. (2006), ‘Accountability sought by patients following adverse events from medical care: the New Zealand experience’, Canadian Medical Association Journal, 175(8): 889894.
Bloom, G., Han, H. L. and Li, X. (2001), ‘How health workers earn a living in China’, Human Resources for Health Development Journal, 5(1-3): 2538.
Cho, H. S., Lee, S. H., Shon, M. S., Yang, S. H. and Lee, H. R. (1998), ‘Reasons why patients and families choose medical dispute’, Journal of Korean Academy of Family Medicine, 19(3): 274291.
Conboy, L. A., Macklin, E., Kelley, J., Kokkotou, E., Lembo, A. and Kaptchuk, T. (2010), ‘Which patients improve: characteristics increasing sensitivity to a supportive patient-practitioner relationship’, Social Science and Medicine, 70(3): 479484.
Creswell, J. H. (2009), Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, Los Angeles: Sage.
Dan, W., Wang, Y., Lam, K. F. and Hesketh, T. (2014), ‘Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Easter China’, BMJ Open, 4: e006431.
DiMatteo, R. M. and DiNocola, D. D. (1982), Achieving Patient Compliance, New York: Pergamon.
Dong, X., Ariana, P. and Xiao, X. (2013), ‘An investigation of Chinese rural doctors’ job-quit intention’, Economic Review, 2: 3039 (in Chinese).
Fan, V. S., Burman, M., McDonell, M. B. and Fihn, S. D. (2005), ‘Continuity and other determinants of patient satisfaction with primary care’, Journal of General Internal Medicine, 20(3): 226233.
Feng, J., Li, Y., Han, C., Xu, L. and Duan, L. (2013), ‘A retrospective analysis on 418 medical disputes’, Chinese Hospital Management, 33(9): 7779 (in Chinese).
Franks, P., Jerant, A. F., Fiscella, K., Shields, C. G., Tancredi, D. J. and Epstein, R. M. (2006), ‘Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators’, Social Science and Medicine, 62(2): 422432.
Gao, J., Tang, S., Tolhurst, R. and Rao, K. (2001), ‘Changing access to health services in urban China: implications for equity’, Health Policy and Planning, 16(3): 302312.
Gu, E. and Zhang, J. (2006), ‘Health care regime change in urban China: unmanaged marketization and reluctant privatization’, Pacific Affairs, 79(1): 4971.
Harris, D. M. and Wu, C. C. (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.
He, J. A. (2010), ‘China’s ongoing health care reform: reversing the perverse incentive scheme’, East Asian Policy, 2(3): 3948.
He, J. A. (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.
He, J. A. and Qian, J. (2013), ‘Hospitals’ responses to administrative cost-containment policy in urban China: the Case of Fujian Province’, The China Quarterly, 216: 946969.
Hermer, L. D. and Brody, H. (2010), ‘Defensive medicine: cost containment and reform’, Journal of General Internal Medicine, 25(5): 470473.
Hickson, G. B., Clayton, E. W., Githens, P. B. and Sloan, F. A. (1992), ‘Factors that prompted families to file medical malpractice claims following perinatal injuries’, Journal of American Medical Association, 267(10): 13591363.
Hsiao, W. C. (1995), ‘The Chinese health care system: lessons for other nations’, Social Science and Medicine, 41(8): 10471055.
Hsiao, W. C. (2008), ‘When incentives and professionalism collide’, Health Affairs, 27(4): 949951.
Hu, T. W., Ong, M., Lin, Z. H. and Li, E. (1999), ‘The effects of economic reform on health insurance and the financial burden for urban workers in China’, Health Economics, 8(4): 309321.
Kaba, R. and Sooriakumaran, P. (2007), ‘The evolution of the doctor-patient relationship’’, International Journal of Surgery, 5(1): 5765.
Kearney, J. (2012), ‘Why China’s 2010 medical malpractice reform fails to reform medical malpractice’, Emory International Law Review, 26: 10391078.
Kessler, D. P., Summerton, N. and Graham, J. R. (2006), ‘Effects of the medical liability system in Australia, the UK and the USA’, The Lancet, 368(9531): 240246.
Kim, S. S., Kaplowitz, S. and Johnston, M. V. (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.
Lee, Y. Y and Lin, J. L. (2010), ‘Do patient autonomy preference matter? linking patient-centered care to patient-physician relationships and health outcomes’, Social Science and Medicine, 71(10): 18111818.
Levinson, W., Roter, D. L., Mullooly, J. P., Dull, V. T. and Frankel, R. M. (1997), ‘Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons’, Journal of American Medical Association, 277(7): 553559.
Li, H., Wu, X., Sun, T., Li, L., Zhao, X., Liu, X., Gao, L., Sun, Q., Zhang, Z. and Fan, L. (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.
Liebman, B. L. (2013), ‘Malpractice mobs: medical dispute resolution in China’, Columbia Law Review, 113: 181264.
Liu, X., Liu, Y. and Chen, N. (2000), ‘The Chinese experience of hospital price regulation’, Health Policy and Planning, 15(2): 157163.
Liu, X. and Mills, A. (2003), ‘The influence of bonus payments to doctors on hospital revenue: results of a quasi-experimental study’, Applied Health Economics and Health Policy, 2(2): 9198.
Rossner, R. M. (2013), Medical liability and the doctor-patient relationship in China, China Medical Board Reports [30 September 2013].
Sewitch, M. J., et al. (2003), ‘Patient nonadherence to medication in inflammatory bowel disease’, American Journal of Gastroenterology, 98(7): 15351544.
Song, F., Yu, Y., Xu, D., Yang, S. and You, B. (2013), ‘An analysis based on 152 cases of medical disputes’, Journal of Traditional Chinese Medicine Management, 21(11): 11671170 (in Chinese).
Stewart, M. A. (1995), ‘Effective physician-patient communication and health outcomes’, Canadian Medical Association Journal, 152(9): 14231433.
Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A., Yoon, C., Puopolo, A. L. and Brennan, T. A. (2006), ‘Claims, errors, and compensation payments in medical malpractice litigation’, New England Journal of Medicine, 354: 20242033.
Summerton, N. (1995), ‘Positive and negative factors in defensive medicine: a questionnaire study of general practitioners’, The British Medical Journal, 310: 2729.
Trummer, U. F., Mueller, U. O., Nowak, P., Stidl, T. and Pelikan, J. M. (2006), ‘Does physician-patient communication that aims at empowering patients improve clinical outcome?’, Patient Education and Counseling, 61(2): 299306.
Vick, S. and Scott, A. (1998), ‘Agency in health care: examining patients’ preferences for attributes of the doctor-patient relationship’, Journal of Health Economics, 17(5): 587605.
Wang, Z. and Oliphant, K. (2012), ‘Yangge dance: the rhythm of liability for medical malpractice in the People’s Republic of China’, Chicago-Kent Law Review, 87(1): 2152.
Weeks, W. B., Foster, T., Wallace, A. E. and Stalhandske, E. (2001), ‘Tort claims analysis in the Veterans Health Administration for quality improvement’, Journal of Law, Medicine and Ethics, 29(3/4): 335345.
Wei, W., Wei, H. and Bai, X. (2013), ‘An analysis on the causes of medical disputes and complaints’, China Medical Archives, 14(9): 1819 (in Chinese).
Wu, H., Zhao, Y., Wang, J. and Wang, L. (2010), ‘Factors associated with occupational stress among Chinese doctors: a cross-sectional survey’, International Archives of Occupational and Environmental Health, 83(2): 155164.
Wu, H., Liu, L., Wang, Y., Gao, F., Zhao, X. and Wang, L. (2013), ‘Factors associated with burnout among Chinese hospital doctors: a cross-sectional study’, BMC Public Health, 13(786): 18.
Wu, Q., Luo, D. and Wang, X. (2014), ‘An analysis on the causes of 94 medical disputes’, Journal of Traditional Chinese Medicine Management, 22(5): 653654 (in Chinese).
Xu, D., et al. (2010), ‘Reformation of medical education in China’, The Lancet, 375(9725): 15021504.
Xu, Z. (2013), ‘The distortion of the doctor-patient relationship in China’, SGIM Forum, 37(2): 1.
Zhang, X. and Sleeboom-Faulkner, M. (2011), ‘Tensions between medical professionals and patients in mainland China’, Cambridge Quarterly of Healthcare Ethics, 20: 458465.
Zhang, Y. and Feng, X. (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.
Zheng, L., Jin, K., Yan, X., Chen, Y., Dong, L., Jin, H. and Tang, J. (2006), ‘Analysis on 111 cases of medical disputes’, China Journal of Hospital Administration, 22(4): 250252 (in Chinese).
Zhou, Y., Li, K., Huang, J. and Feng, G. (2011), ‘Factors influencing the doctor-patient relationship and policy recommendations’, Chinese Hospitals, 15(9): 5861 (in Chinese).
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Health Economics, Policy and Law
  • ISSN: 1744-1331
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