Abstract
This paper aims to study the legitimacy and implementation of China's Physician Multisite Practice policy from the perspectives of government officials, hospital administrators, doctors and patients. For the purpose of this article, PMP is used as the unified abbreviation of Physician Multisite Practice. PMP is when physicians practice in more than one location, which is common globally, and is one of the major topics in modern healthcare management. In China, one of the government's goals in promoting PMP is to seek improvement in patients' access to quality medical care resources. Prior to 2004, PMP was illegal for Chinese doctors. Since 2004, the 《Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System》proposed to allow doctors to practice at multiple sites (PMP) under the management of the government. However, hospital administrators do not support government-led PMP and doctors have been actively trying to circumvent government management, conducting private PMP outside government management channels ever since.
The purpose of this study is to uncover the experiences and perspectives of Chinese government officials, hospital administrators, doctors and patients on PMP, through empirical and theoretical research, so as to find out the reasons for the unsuccessful implementation of government-led PMP-related policies, discuss the legitimacy of related policies, explain the reasons for the epidemic of private PMP, and finally propose a better method to better promote the government-led PMP. Studying this topic is of great significance for finding appropriate policies for China's healthcare reform, improving hospital management and operation, improving the relationship between hospitals and doctors and patients, increasing doctors' incomes, and increasing patients' satisfaction with medical services.
The study includes the following components: a questionnaire survey of 660 patients and 188 doctors; in-depth interviews with twelve government officials, hospital administrators, and PMP participants; and an case analysis of the Hongdong County doctor’s red envelope case. This study analyzes the opinions of government officials, hospital management, doctors, and patients on the current situation of medical services and the government-led PMP system. This study uses the Smith model and the theoretical framework of Scott's three-pillar legitimacy in neo- institutionalism, and comprehensively analyzes the legitimacy of Chinese PMP through the definition and analysis of Qing (Situation or Affection), Li (Logic or Reason), and Fa (Law or Rule) in traditional Chinese culture.
We found that the government-led PMP policy does not have the full support of government officials, hospitals, doctors, nor patients. According to the Smith model, government-led PMP is therefore deemed as a failure. The study found that patients didn't care if PMP was legitimate, and for them, private PMP made them feel more engaged and trusted. The study found that due to the lack of trust between doctors and patients, there is no natural trust between multi-site practitioners and subordinate hospitals, so doctors need to rely on their familiar subordinate hospitals as intermediaries for doctors PMP to eliminate trust barriers with patients. Thus, most of the multi-site practitioners will look for subordinate hospitals by themselves and will not accept government-appointed hospitals, which is another important reason for the popularity of private PMP.
The study also found that in traditional Chinese culture, Qing and Li account for a greater proportion than Fa, and this influence has been passed down to this day. The results of the study show that legality does not mean full legitimacy. The legality is only one-dimensional, and legitimacy is regulative, normative and cognitively three-dimensional. The results show that the PMP policy led by the Chinese government has not been supported by hospitals, doctors, nor patients, so it has legality but only has the legitimacy of regulation. It does not have the legitimacy of the cognitive or normative. The private PMP led by the doctors themselves is only regulated illegally, and it can be better understood and accepted by doctors and patients, resulting in its cognitive and normative legitimacy. Traditional Chinese culture gives partial legitimacy to private PMP, which directly hinders the implementation of government-led PMP. The results of the study show that there is actually room for private PMP within the field. The results of the study shows that the government needs to revise policies, increase investment in the field of medical services, increase the income of medical personnel, and reduce the price of medical services, in order to fundamentally improve the relationship between the government, hospitals, doctors, and patients, enhancing patients' trust in the medical system, and ultimately solve the problem of private PMP so that government-led PMP policies can be successfully implemented.