Violent Disputes in the Chinese Medical Sector: the “Yinao” Phenomenon

Patients wait to be seen at a crowded hospital in Sichuan province, China (Credit: Jiong Tu)

Memo #278

By Jiong Tu – jt457 [at] cam.ac.uk

The medical sector in China has witnessed increasing disputes between doctors and patients over the past several years. According to a 2012 report, medical disputes in China had increased at the rate of 22.9 percent annually since 2002, and are now one of the country’s biggest social problems. China’s CCTV reported that in 2010 alone there were 17,243 medically-related disputes, an increase of almost 7,000 cases compared to five years ago. Yinao (or “medical disturbance,” the term generally given to these disputes) can take various manifestations, including displaying a corpse at a hospital, blockading a hospital entrance, destruction of property, or worse. What makes these medical encounters especially disturbing is their potential for violence. The official People’s Net claims over 10,000 Chinese health professionals are attacked or injured every year. Many of the medical professionals at the receiving end of these attacks see themselves as victims not just of angry patients but of a failed medical system.

Various factors contribute to this increase in medically-related disputes: a rising consciousness of patient rights, the deepening misunderstanding between patients and doctors, inflammatory media reporting, and the absence of a formal institution for dealing with medical disputes. Underlying all these factors is the market-oriented reform of the Chinese health sector, ongoing since the 1980s. As the Chinese state has retreated from health care provision, patients have been forced to take responsibility for overseeing their own care. Many do not seek health care until their condition becomes serious, and for major illnesses, people can exhaust their life savings. If treatment fails, the despairing patients and their families often direct blame at doctors and hospitals.

Further, in the market era, Chinese health professionals and hospitals have been required to become self-sufficient. Underpaid doctors often turn to ‘grey’ sources for income: drug kickbacks, bribery, over-prescription, etc. In the process, the image of doctors has gradually changed from that of benevolent angles selflessly ‘serving the people’ to monsters in white cloth. When medical accidents or misfortune happens, doctors often become the direct targets of resentment and revenge.

Doctors employ a “scalpel vs. dagger” metaphor, protesting that they use a scalpel to save patients only to be “repaid” by the dagger. Doctors regard themselves as the scapegoats of health system issues and the inaction of a government that has reduced its involvement not only in health care investment, but also in mediating conflicts.

Jiong Tu is a PhD candidate in the Department of Sociology, University of Cambridge.

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Patients wait to be seen at a crowded hospital in Sichuan province, China (Credit: Jiong Tu)

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