Relational Work in Intermediated Ties: The Dynamics of Guanxi in Hospital Care in China

Abstract

Based on an ongoing ethnographic research on hospital care in China, this paper examines why and how intermediaries and medical service providers engage in helping the service seekers that they do not know. When “quality medical care” is in short supply and public hospitals are undergoing corporatization, patients are mobilizing their guanxi (social relationships) to obtain preferential treatment and better care. Intermediaries play a critical role in connecting service seekers to service providers. As there are many seekers but only limited number of providers, many seekers rely on indirect intermediaries for help. These intermediaries’ motives for helping those they do not know vary from sympathies, to obligations, and favor exchanges. Tie strength is found to be an important variable that affects intermediaries’ willingness to help, as well as the seekers’ chance of obtaining preferential treatment. Indirect reciprocity in multiple levels of intermediations is also achieved through the intermediaries. This paper illustrates how relational work is performed and constantly negotiated among different groups of actors.