Legitimacy and professional boundaries: An institutional analysis of Chinese Medicine in Mainland China and Hong Kong

Abstract

The legitimacy of complementary and alternative medicines (CAMs) and their integration into mainstream healthcare have long been a topic in sociological discussions. This study examines the institutional influences on Chinese medicine (CM), an important CAM in mainland China and Hong Kong. In-depth interviews with practitioners and observations in public hospitals facilitate a comparison of the professional boundaries, statuses, and jurisdictions of CM in the two regions. In mainland China, CM has a high degree of state-granted legitimacy with blurred professional boundaries between CM and Western medicine (WM) in a highly integrated healthcare system. However, these blurred boundaries have had the following unintended consequences: (i) devaluation of traditional knowledge in CM education and practices, (ii) biomedicalisation of CM practices wherein a substantial reliance on WM has decreased the utilisation of healing principles in CM and (iii) ambiguity in the efficacy of CM due to the co-use of CM and WM. In contrast, the demarcated professional boundaries in Hong Kong have allowed CM to maintain its knowledge base, even though CM is practised within strict parameters. This study reveals that institutional requirements (on efficiency, accountability and profitability) prioritise the biomedical model and drive the biomedicalisation of CM. Therefore, the lack of clear professional boundaries in the current integrative medical system in mainland China have eroded the knowledge base of CM and undermined the efficacy-based legitimacy of CM.