No end to China's medical disputes

Reports of patient attacks on medical staff have been on the rise in recent years. The latest of such incidents - a fatal stabbing of Dr Yang Wen in her neck while she was at work at Beijing's Civil Aviation General Hospital on 24 December 2019 - has placed the growing societal issue in the spotlight.

Medical disputes are a relatively new phenomenon in China's history. During the 1980s, doctors in China were regarded as selfless angels in white who enjoyed high social status and reputation.

However, ever since the hospitals' implementation of a corporate management style - where hospitals are self-financed and profits are driven by expensive drugs - there has been an increasing number of cases of doctors ordering unnecessary medical tests, accepting hongbaos (monetary gifts in red packets), pocketing drug rebates, and delivering poor service. The public's negative perception of the profession has increased, and people are losing trust in doctors. As a result, disputes between doctors and patients are intensifying, resulting in horrific incidences of medical criminal cases.

Medical disputes are common in various countries around the world, and are mostly resolved through undertaking legal action. Rarely do we find such intense and violent medical disputes like the ones in China. Various reasons account for this rising social phenomenon.

Relevant studies once systematically consolidated medical criminal cases that occurred between 2012 and 2017. Offenders in over 81% of these cases didn't graduate from high school. 66% of the reasons given for dispute involved a dissatisfaction towards treatment effect, where symptoms were either not alleviated, or that death occurred. Tier 1 hospitals were where most of these disputes occurred. Notably, medical disputes mainly emerge from the patient's high expectations of treatment effects, which is in turn closely related to their low education background, lack of scientific and medical knowledge, and relatively low level of socioeconomic development.

Many patients do not understand medical procedures, or simply disrespect them and are unwilling to cooperate during the process of treatment. They commonly hide their medical records, avoid medical checks, demand to have a certain kind of treatment administered, and wilfully intervene in the treatment process. At the same time, they have sky-high expectations for treatment effects, thinking that going to the doctor's would mean "treatment upon admission, healing upon taking medication, and curing upon undergoing surgery". They also believe that "there should be no dead persons at the hospital". Once things fail to go their way, great resentment towards the medical staff is built up.

On the other hand, hospitals have, for a long time, made money through selling drugs, which resulted in various healthcare problems. It is also true that some medical staff prescribe more medicine than necessary, order check ups that are not needed, and accept hongbaos and pocket rebates. All these actions have brought much harm to society's perception of the profession. However, the underlying reasons for this phenomenon are closely related to China's current healthcare policies.

In their single-minded pursuit of market-oriented healthcare reforms, the authorities have forgotten that public welfare institutions do not receive adequate governmental support. China's hospitals adopt a dual policy scheme: administratively, it is part of China's planned economy, but financially, it operates under corporate management and is self-financed. For the sake of profit, hospitals will inevitably force medical staff to find ways to increase revenue.

At the same time, salaries of medical staff are administratively controlled, and thus cut down. The reason why China is able to provide quality healthcare services at a relatively lower price is partly due to its exploitation of medical staff. The public's complaints of having difficulties in seeking treatment and the high costs that come with it, thus cannot be entirely blamed on steep consultation fees fixed by the hospitals.

Relatively speaking, the cost of China's healthcare services is not expensive when compared with the rest of the world. The so-called exorbitant consultation fees are the result of an inadequate social security system. Hence, once hit with a major illness, it seems as if patients are returning to "poverty" again.

On the other hand, difficulties in seeking treatment can be attributed to limited healthcare resources and unequal distribution of these resources. The market is an invisible hand - even if administratively-controlled hospitals implement a strict control on medical expenses, inexpensive yet quality healthcare services are still unable to cater to the needs of the large number of patients. To a certain extent, hongbaos are the market's way of "reverse compensation" in response to biases in administrative management.

For a long time, the core of China's healthcare policies lay in lowering the quality of healthcare services, lowering the entry requirements of medical staff, cutting down state investment, and catering to the needs of as many people as possible. However, the patients' expectations are to receive quality yet inexpensive healthcare services, have quality medical staff serve them, and to be able to pay as little as possible to receive all of those. Thus, intrinsic contradictions exist between healthcare policies and patients' expectations.

Hence, current medical disputes are simply a manifestation of the discrepancy between healthcare policies and the reality of the healthcare industry. In the short term, there seems to be no solution to these disputes.