Government Responsibility Shift and Medical Dispute Resolution in Contemporary China: Study on Medical Dispute Mediation Committees

China usually faces a dilemma in disputes resolution and conflicts management. On the one hand, the authoritarian regime requires an efficient dispute resolution system; hence the institutionalization of disputes resolutions should be strengthened. On the other hand, in order to maintain the official ideology, especially following the mass line instructions, the authoritarian regime usually takes irregular governance strategies and tactics to break the institutionalized practice. This causes two problems in the dispute resolution and conflict management in China. First, the low efficiency, high costs and large amounts of long-pending cases bring about huge...[ Read more ]

Government Responsibility Shift and Medical Dispute Resolution in Contemporary China: Study on Medical Dispute Mediation Committees

China usually faces a dilemma in disputes resolution and conflicts management. On the one hand, the authoritarian regime requires an efficient dispute resolution system; hence the institutionalization of disputes resolutions should be strengthened. On the other hand, in order to maintain the official ideology, especially following the mass line instructions, the authoritarian regime usually takes irregular governance strategies and tactics to break the institutionalized practice. This causes two problems in the dispute resolution and conflict management in China. First, the low efficiency, high costs and large amounts of long-pending cases bring about huge social pressures on the central and local governments. Second, the concentrations of responsibilities causes the concentrations of blame from citizens, which may harm the legitimacy maintenance.

Two major approaches may contribute to deal with these problems. The first approach is to strengthen the judiciary system, which has its own limitations. The second approach is to shift part of government responsibilities and to encourage the development and involvement of social organizations in dispute resolution and conflict management. While the former approach has been systematically studied, the latter approach has been rarely studied. In this dissertation, I would like to employ the case of medical dispute mediation committees and explore the incentives, operation rationale and consequences of the state after the governments’ responsibilities have been partially shifted to the social organizations.

Based on the archrival datasets of more than 1300 cases from Province G, large numbers of interviews and field work in Province G, Municipality S and Province H, as well as the secondary public datasets, including more than 300 litigations, this paper employs the quantitative and qualitative analysis and has the following findings. First, the establishment and existence of medical disputes mediation committees are able to meet the multiple demands of hospitals and patients, which can help to overcome the limitations of previous resolution approaches. Second, it provides multiple incentives for hospitals, patients as well as administrative organs and legal organs, including economic incentives, political incentives, bureaucratic incentives and professional incentives. With regard to the operation rationale of medical disputes mediation committees, this study finds out state interventions into the medical disputes resolutions are conditional or selective after the medical disputes mediation committees have taken the responsibility of dispute resolution. Two mechanisms may influence state’s interventions into the medical dispute resolutions. One, the patients’ tactics and strategies may enhance the probability of state interventions. Two, the state may be able to intentionally intervene in some special cases based on the considerations of potential risks of medical disputes. As a result, the state’s intervention modes are becoming more subtle and can be classified into three kinds: intervention as a decision maker; intervention as an advisor; delegations without direct involvement. In different modes of state interventions, the mediation committees’ autonomy degrees varies and play different roles in the medical disputes resolution. Different styles of mediation committees have been various in different regions, which are affected by the factors including the medical resources, resources variances and the local leaders. Finally, a controversy is found. The professional capacities of mediation committees may still face the pressure from the selective and conditional state interventions. In addition, conditional and selective state interventions may cause grievance for medical staff and strengthen the patients’ belief in the effectiveness of trouble making.

This study s significant in practice. According to this study, the MDMC may contribute to reduce the pressure in administrative governance of local governments in governance and enhances the efficiency and effectiveness of conflict management. However, it fails to completely resolve the dilemma the authoritarian regime faces.

This study tries to respond to theories in two different aspects. First, existing studies in dispute resolution and conflict management focus on the state’s mechanisms of containing and resolution of disputes. Other than the legal approach absorption and coercive repression, this study provides a new example of governance of soft style through systematic study on the medical disputes resolution in an authoritarian setting, responding to the relative controversy over the mediation institutions in social conflicts resolution. Second, this study also tries to contribute to understanding of the relationship between state and social organizations from the perspective of professionalization.

Key words: Medical Disputes Resolution, Mediation, Responsibility Shifting, China