A market of distrust: unofficial payments for Hospital Care in China

Abstract

This study examines the mechanism through which distrust constitutes and organizes an illegal market of gift and favor exchanges in the hospitals in urban China. Based on ethnographic studies in public hospitals in four Chinese cities in 2011-2013, this paper presents how the corporatization of hospital care in post-Mao China resulted in generalized distrust in hospitals and physicians. This distrust induced patients to revive a tradition of delivering hongbao (red packets containing money) to physicians, but imbued it with new meanings and new practices. It argues that patients or their family members offer hongbao not only to gain preferential treatment, but also to buy an obligation from the physicians of whom they generally distrust and to abate the insurmountable fear and anxieties. However, physicians also displayed generalized distrust in patients, and consequently they refrain from accepting hongbao offered by those without guanxi (interpersonal connections). Hongbao exchanges, thus, are highly associated with the use of guanxi, and their category has shifted from “bribery-oriented” to “gift-givingoriented.” This case sheds light on how and under what conditions distrust could generate an illegal market and shape its pattern of operation.