Changing of China׳s health policy and Doctor–Patient relationship: 1949–2016

Highlights

• Summarize the changes of China health policies and doctor-patient relationship during 1949–2015.

• Divided China׳s health policy into three stages.

• Reports escalating tension between doctors and patients in China.

• Insufficient medical resources, "reimbursement" policy and a "non-neutral" medical lead tense doctor-patient relationship.

Abstract

Objective

To identify the changing of health policy decisions and Doctor–Patient relationship in different periods in China during 67 years (1949–2016).

Methods

We followed a systematic approach to analyze the development stage of China׳s healthcare reform and Doctor–Patient relationship over time. Based on the extant literature and statistical data, the current five issues in Chinese health policy and three aspects of Doctor-Patient Relationships are classified. The reasons for the current situation and recommendations for future policy are discussed.

Results

There are four main problems of Chinese Health Policy: funding shortage, excessive market-oriented operation, health insurance limited reimbursement amount, and media coverage a lot of non-neutral health events. In different historical periods, these problems are not prominent, but have become increasingly serious in recent years. On the other hand, three participants contributed to the growing tense relationship between doctors and patients: doctors (hospitals), patients and governments.

Conclusions

In formulating future health care policy, the government should change: increase investment in the medical field, change the income structure of doctors and hospital, propagate medical news in an objective way, and increase the amount and scope of medical insurance repayment.

Introduction

Health systems worldwide struggle to meet increasing demands for health care, especially in a country which has a large population. Due to this, health care is one of the most important issues of government. Over the past 67 years, the Chinese government has gone to great lengths to enhance the medical care standards of the 1.4 billion Chinese people. The Chinese government has committed to provide affordable and equitable basic healthcare for all its citizens by 2020.

There are two contrasting points of Chinese healthcare that have attracted attention around the world. One is the enormous progress in Chinese public health, and the other is increasingly acute conflicts between doctors and patients.

For decades, China has achieved remarkable progress in health care. The average life expectancy of the Chinese population increased from 35.2 (1949) to 76.1 (2016), the maternal mortality rate dropped from 108.8 per million (1949) to 2.1per million (2016), and the infant mortality rate from 21.6% (1949) to 0.8% (2016). These three key indicators are significantly better than the United Nations Millennium Development Goals [Data sources: National Scientific Data Sharing Platform for Population and Health; Chinese Center for Disease Control and Prevention]. The Chinese practice of healthcare has an important reference for other countries [1]. Since the Chinese medical system is completely under government management, more than 90% of hospitals are state-owned, and health insurance is funded entirely by grant funds. For the overall welfare of public health in China, health policies are essential [2]. To summarize the experience of China׳s health services, we describe the change its health care policies over time.

Another focus of attention around the world is the Chinese doctor–patient conflicts. In most countries, there is a good relationship between doctors and patients: doctors abide by professional ethics and make every effort to treat patients; on the other side, patients trust doctors sincerely and take a tolerance attitude toward doctor׳s treatment plan [3]. However, China׳s doctor–patient relationship has become increasingly tense in recent years coming to “irreconcilable edge "[2]. The vicious criminal cases of “patient hurts medical staff” occur frequently on the news. The occurrence rate of patients and their relatives taking drastic action in medical disputes in China is more than 73.5%. In these drastic actions, 45.2% damaged hospital equipment, 35.4% led to the medical personnel injury, and 90.5% patients were detained or refused to pay medical expenses. On October 25, 2013, in the first people׳s hospital in Wenling City, patient LIAN Enqing conducted a knife attack, leading to the stabbing of three outpatient doctors, and death of senior attending, WANG Yunjie. (On May 25, 2015; the murderer was executed). On May 18, 2016, in Hunan Province Shaodong People׳s Hospital, ENT doctor Wang Jun was attacked and killed by his patient׳s family members. The frequency of such events has led to the relationship between Chinese doctors and patients becoming very fragile, with a lack of mutual trust.

According to statistics from National Health and Family Planning Commission of the People׳s Republic of China (2001–2016), the number of events disrupting medical service increased from 4914 to 20,833 cases [4], [5], [6]. These events included: 1807 health care workers hurt by patients in the year of 2001, increasing to 8537 persons in 2016; hospital property losses of CN¥54.1 million (US$8.2 million) in the year of 2001 increasing to CN¥304.7 million (US$43.5 million) in 2016. According to the 2016 survey of 326 hospitals nationwide by Chinese Hospital Association, 98.4% had medical disputes in 2015.The average number of disputes in general hospitals each year was 11.6, but 25% of general hospitals reported an average of more than 30 disputes each year. In order to deal with medical disputes, the hospital spends about 5.9% of its total revenue on compensation. In 2015, total compensation of these surveyed 326 hospitals was more than CN¥4.2 billion (US$604.6 million), an average of 12.9 million (US$1.8 million) for each hospital.

Over time, the Chinese health policy can be classified into three stages; almost at the same time, the relationship between doctors and patients in China can also be divided into three stages. Is it a coincidence, or inevitable phenomenon? This paper attempts to systematize the evolution of China׳s Health Policy and the doctor–patient relationship, to describe the correlation between them.