State control and doctors’ abuse of clinical autonomy: An empirical analysis of doctors’ clinical practice in Chinese public hospitals

Abstract

Medical doctors enjoy a high degree of professional autonomy because they own and apply professional knowledge in helping patients. Therefore, laymen are unable to evaluate doctors’ clinical practices. For this reason, how to exert effective social control over doctors’ work has been a significant question in the sociology of professions. Based on fieldwork in Beijing, government statistics, and others’ research findings, this paper analyzes the working conditions and clinical practices of Chinese urban doctors. I find that medical professionals are still dependent upon public hospitals that continue dominating the healthcare delivery system, and thus they lack corporate autonomy and are incapable of negotiating working arrangements, payment for their services and their incomes with the state. This condition generates a distortion in doctors’ labor value. However, also because of the domination of the healthcare delivery system, public hospitals and their doctors have gained ‘dual dominance’ over both patients and pharmaceutical enterprises, by which doctors transform their rights of prescription into economic benefits. This informal income, including hongbao (red envelopes containing money) and kickbacks, compensates for doctors’ relatively low formal incomes resulting from the state’s control. However, doctors abuse clinical autonomy constantly and pervasively, by which they transform their monopolies of medical expertise into economic benefits. This also means that the regulation and supervision of health administration is unsuccessful, as is the profession’s self-regulation. Hence, this paper suggests that if the medical profession can effectively participate in health policy-making, medical professionals be given the right of free practice, and non-public medical institutions given the same status and policy treatments as public hospitals, these problems in the current healthcare system will be relieved or solved.