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Title: The changing relationship between the state and medical profession in contemporary China : case studies in Beijing
Other Titles: Dang dai Zhongguo bian hua zhong de guo jia he yi xue zhuan ye guan xi : Beijing ge an yan jiu
當代中國變化中的國家和醫學專業關係 : 北京個案研究
Authors: Yang, Yaning (楊雅寧)
Department: Dept. of Public and Social Administration
Degree: Master of Philosophy
Issue Date: 2007
Publisher: City University of Hong Kong
Subjects: Medical care -- China -- Beijing -- Case studies
Physicians -- China -- Beijing
Notes: CityU Call Number: RA395.C53 Y36 2007
Includes bibliographical references (leaves 190-202)
Thesis (M.Phil.)--City University of Hong Kong, 2007
xi, 203 leaves : ill. ; 30 cm.
Type: Thesis
Abstract: The economic reform in China in the late 1970s provides a great opportunity for the development and prosperity of the medical professions. However, the studies on medical professionalization in China are not as developed as in the western countries. The principal goal of this study is to explore the particular characteristics of medical professionalization in contemporary China and to answer the question of whether it is a state-led or professional-led process or another type. Furthermore, more specially, since the state-profession relationship is very crucial in the process of professionalization, this study tries to examine what kind of relationship exists between the state and medical profession and the impact of such relationship on medical professionalization. The present study employs the occupational control approach to study medical professionalization in contemporary China. At the same time, corporatism and clientelism are the main theoretical frameworks used to explore the relationship between the state and medical profession. The analysis is divided into three levels: macro-level, meso-level, and micro-level. Case studies are conducted in Beijing which is China’s political center and in the front line of modernization and professionalization. In-depth interviews and documentary analysis are the two main research methods. In macro-level analysis, this study mainly uses the method of documentary analysis to analyze medical professionalization under the institutional transformation since the economic reform. In meso-level analysis, this study uses the Chinese Medical Doctors Association as a case to explore the relationship between the state and medical professional associations in constructing a new regulatory system. In micro-level analysis, this study focuses on the medical professionals’ and local government officials’ perceptions of professionalization, the clinical autonomy enjoyed by medical professionals, and the relationship between the local government and local hospitals. One public hospital in Beijing is selected as a case. From these analyses, firstly, this study discovers that due to China’s unique political and institutional background, the medical professionalization in contemporary China is a state-led process, but it has its own characteristics which are different from the western countries. Medical professionalization has been used as a strategy by the transitional state to enhance its governance when its power retreats from the health sector. Secondly, the relationship between the state and medical profession is in transition and has not reached the status of state corporatism or societal corporatism but has some clientelistic characteristics. The state-planned and state-control model for managing professions has disintegrated, but a new model has not been properly established, thus leading to some chaos and inconsistency between the state and medical professions. Thirdly, due to the economic transition, medical professionals are behaving just as institutional stakeholders to construct a new relationship with the government through their ongoing negotiations for resources and regulatory power. The rent seeking behaviors of the medical professionals caused by the disintegration of the old state-planned and state-control model and the underdevelopment of self-discipline model for managing the medical profession have eroded the trust between the medical professionals and the public, which in turn have an adverse effect on the process of medical professionalization. The significance of this study is three-fold. First, it sheds light on the process of medical professionalization in contemporary China which has not been explored in depth before and broadens the understanding of the theories on professionalization. Furthermore, by exploring the relationship between the state and medical profession, this study helps the researchers and policy makers understand the real power relations between these two important stakeholders in the health sector. This is a new perspective for the research on China’s healthcare system. Thirdly, the relationship between the state and medical profession as one of the indicators of state-society relationship provides a relevant perspective to the understanding of transitional China.
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