Transformations in doctor–patient responsibilities in China’s quasi-marketised healthcare system

TL;DR

China's healthcare system reforms have shifted responsibilities from institutions to doctors and patients, creating new pressures and challenges.

Contribution

The study introduces the concept of 'privatised responsibilities' to analyze the effects of quasi-marketisation in healthcare.

Findings

Marketisation has increased individual burdens on doctors and patients in healthcare access, coordination, and financing.

Doctors face pressures in fragmented services, while patients must navigate care and costs independently.

Institutional theory reveals how regulative, normative, and cultural-cognitive factors shape these responsibilities.

Abstract

Following a series of systemic reforms, China’s healthcare system now takes a quasi-marketised form, with an uneasy combination of state regulation and market mechanisms, which has fundamentally reshaped the distribution of responsibilities between doctors and patients. This study employs institutional theory to analyse the institutional factors in shaping the doctor-patient responsibilities within the current healthcare system.

This qualitative study involved thematic analysis of semi-structured interviews with 28 doctors and patients from various provinces in China. Participants were purposively selected to reflect diverse experiences across healthcare settings. Thematic analysis was conducted to identify and interpret key patterns within the data.

Three main dimensions of privatisation emerged from the analysis: accessing healthcare, care coordination, and healthcare financing. Findings indicate that marketisation has significantly increased the responsibilities placed on individual doctors and patients, effectively transferring systemic burdens to these individuals. Doctors face intensified pressures to manage care within fragmented health services, while patients confront greater personal responsibility in navigating access to care, coordinating their treatments, and handling healthcare expenses.

This study extends the application of institutional theory to the healthcare context. It demonstrates the regulative, normative, and cultural–cognitive dimensions of the healthcare system in shaping and constructing of doctor–patient responsibility. The concept of privatised responsibilities proposed here provides a useful theoretical lens for analysing the effects of quasi-marketisation and offers a foundation for future research on doctor-patient responsibility and accountability in healthcare systems.