title: The contemporary healthcare crisis in China and the role of medical professionalism.
abstract: The healthcare crisis that has developed in the last two decades during China's economic reform has caused healthcare and hospital financing reforms to be largely experienced by patients as a crisis in the patient-healthcare professional relationship (PPR) at the bedside. The nature and magnitude of this crisis were epitomized by the "Harbin Scandal"-an incident that took place in August 2005 in a Harbin teaching hospital in which the family of an elderly patient hospitalized in the intensive care unit (ICU) for 66 days paid over RMB yen6 million. The news was publicized globally and ended in the firing of six top hospital administrators including the hospital president and the ICU director. This paper seeks to show that the Chinese healthcare crisis is ultimately linked to a conflict of interests between patients and healthcare professionals (HCPs), which is inherent in the reformed healthcare system of China. Hence the crisis is, at its core, a crisis of fidelity and confidence that must be restored to the PPR. At the "macro" level, it is simplistic to blame the crisis on the failure of the market system, and at the "micro" level, it is naïve to expect that a contractual understanding of the PPR will effectively restore the confidence of patients. This paper will show that the fiduciary relationship and medical professionalism share similar attributes, with fidelity being the core value of both. It concludes that the loss of medical fidelity implies the dissolution of the PPR and the demise of the medical profession and challenges Chinese HCPs to keep their fidelity as a means to both protect their patients' interests and to preserve their profession's survival.
authors.affiliation: LKS Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China. edwinhui@hkucc.hku.hk
authors.forename: Edwin C
authors.initials: EC
authors.lastname: Hui
mesh_terms: D002681:China; D016265:Conflict of Interest; D003695:Delivery of Health Care / Q000941:ethics / Q000458:organization & administration*; D018166:Health Care Reform / Q000941:ethics / Q000458:organization & administration; D006739:Hospital Administration; D006801:Humans; D010686:Philosophy, Medical; D011369:Professional-Patient Relations / Q000941:ethics*; D013222:State Medicine / Q000941:ethics / Q000458:organization & administration*; D035502:Trust