Hospital on fire : politicized medical dispute resolution in China

Abstract

What drives patients to adopt “hospital violence” (yinao, 医闹) under an authoritarian regime? What turns medical disputes between patients and doctors into a form of social conflict between citizens and society? How does the government intervene to address medical disputes? This dissertation addresses these questions through an in-depth empirical study of medical dispute resolution in China. I argue that the authoritarian regime applies institutional channels to absorb personal grievances through making selective punishment and compensation distribution the means of preventive covert repression to counter collective actions. Through the revitalization of the People’s Mediation Committee (renmin tiaojie, 人民调解), social disputes have been politicized into a bargaining process between the government and individuals to maintain social stability. I adopt mixed methods (both qualitative and quantitative) to support this argument. This dissertation is mainly composed of three empirical studies. First, to understand medical dispute resolution, I spent two summers and winters from 2015 to 2017 conducting fieldwork in Shanghai, China. I conducted 72 in-depth interviews with patients, medical workers, and street-level officials (mediators and police officers), and I describe the everyday practices among street-level officials in dealing with medical disputes. Second, I compiled 156 media reports on hospital violence from the timeframe of 2010 to 2017 to observe coping strategies towards the noncompliance behaviours of hospital violence. Third, I quantitatively studied the rationale for compensation distribution by the government-sponsored People’s Mediation Channel, drawing on the 763 mediated medical dispute cases at one location in Shanghai. The dilemma of maintaining social stability and being responsive towards personal grievances affects the daily practices of dispute resolution. I argue that social dispute resolution in China is politicized. The Chinese government develops institutional channels to absorb personal grievances and address non-political disputes to prevent social disputes from escalating into collective actions. Selective punishment and over-responsiveness towards personal grievances can also diminish the consistency of law enforcement and introduce conflict with the rule of law in China. However, the overall all-encompassing stability maintenance institutions can encounter long-term troubles in delivering consistent law enforcement.