Abstract
Chinese patients frequently give ‘gifts’ to health professionals. Yet, transformations in the Chinese society over the past decades are reshaping the everyday gifting practice. Under the market reforms, gifts from patients to doctors have changed from mostly symbolic and material forms to increasingly monetary form. Gifts can be sincere expressions of gratitude from patients and are used by patients to cultivate relationships with doctors in a reciprocal manner. They are also actively used by patients to overcome systemic obstacles that prevent them from obtaining quality health care. In the market, gift practice also enables health professionals to transfer their skills, expertise and professional power to economic profits and dominance over patients. Gifts can be regarded as an economic compensation for the low-valued labour of doctors, but when gifts are excessively demanded, they become a channel used by doctors to generate wealth. The theoretically ‘voluntary’ gifting increasingly becomes obligatory in practice.
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Notes
- 1.
With regard to the redundant, Cheal means that gifts add nothing to their recipients, bring no net benefit to their recipients, are often things that the recipients could have provided for themselves, and are ritual offerings for the purposes of interaction courtesy.
- 2.
There are some researches about ‘red-packets’ and kickbacks in the Chinese medical sector, but mostly in the area of ethics and philosophy (Qiu 2006; Wang 2005a, b). There is a lack of empirical research and the research from the sociological and anthropological perspectives, due to the difficulty to carry out research and obtain relevant data. Gifting in the health sector is carried out behind closed door or under the table, thus it is difficult to quantify gift practice and its efficacy. However its prevalence in people’s accounts of health care makes it unignorable.
- 3.
The description of the changing gift practice in this section is a generalisation of local’s accounts (especially local elderly’s accounts) when they compared gifts in the past and that now in the medical sector. Although I followed locals’ accounts and depicted the change of gift in a linear way, I do admit that the change of gift overtime is not linear, and the changes of gifts in the rural and urban areas are also different.
- 4.
This does not mean that the exchange of material and symbolic gifts in the traditional context does not involve calculation. The emotional indebtedness and reciprocity in traditional gift practice also involve a calculation of contributions, but this calculation has a different texture of feeling than the market calculation. The universal capacity to calculate should not be confused with the market calculation that subjects everything into economic evaluation.
- 5.
The rising consideration about health, food security, product quality, etc. makes giving a suitable material gift difficult.
- 6.
Material gifts are still given by patients sometimes, but frequently accompanying cash gift.
- 7.
Red packets were traditionally used in occasions like festivals, weddings, and birthday celebrations to convey good wishes. Red packets were also used as bribe in the past. However, most of these practices were taken within the relations of certain proximity or in the officialdom. Red packets were seldom used in the health sector, where most doctors worked privately in traditional society.
- 8.
Following the locals’ accounts, I put red-packets (money) into the broad discussion of gifts, although I am conscious about the difference between gifts and red-packets (as informal payments). In my field, both patients and health professionals categorise red-packet as gift. For doctor, it helps them to justify their red-packet receiving behaviour (because it is within the traditional gift practice), therefore disguises red-packets’ extortion nature. For patients, it helps them to compare red-packets now with material gifts in the past, to reveal their change and extortion nature, and therefore criticise red-packets.
- 9.
The situation began to change recently due to the government’s promotion of natural birth.
- 10.
Inspiration got from ‘Making Capitalism Fit for Society’ (Crouch 2013).
- 11.
The function of gift to contribute to the humane health care has also been noted in other societies, such as the former Soviet Bloc. Research bribes and gifts in Russian Heath Care, Rivkin-Fish (2005) suggests that these unofficial payments, bribes and gifts make health care between patients and doctors become more personal and humane; they make sense as ethical forms of interaction within the broader context of institutional changes taking place in the post-Soviet era.
- 12.
- 13.
The amounts of red-packets are higher in higher level hospitals and big cities.
- 14.
If the amount a patient’s family gives is lower than usual, they should explain to the doctor a little about their difficult financial situation, but red-packet is not necessary if the patient is introduced through a close acquaintance.
- 15.
This still occasionally happened in the rural areas of Riverside County.
- 16.
I describe the changes of gift practices overtime earlier in this chapter, but claim that the gift practice still follows the rule of reciprocity here. It seems conflicting, but what I want to show is a transitional process, an on-going changing situation. This changing tendency arouses people’s resentments, that is why there are such violent reactions from patients as shown in Chap. 6.
- 17.
Gift here is a broad concept. Although the financial contribution I discuss in this section is more like official bribe rather than a gift in more traditional sense, it has been put in the broad discussion of gifting by my interviewees. The relationships between a gift and a bribe, between gifting and corruption are obscured in official regulations, media reports and people’s discourses.
- 18.
Searching online, I also found this doctor had written some posts on the internet to reveal the corruptions involved in her hospital and the threats and sufferings she endured during the past few years. After the media report, the ‘crazy’ doctor received much public sympathy and support. She was depicted by the media and public as a ‘heroic’ figure who defended patients’ interests and upheld conscience against the corrupt health sector. In 2014, after many media reports and wide public attention, the higher level authority began to investigate the hospital. However, it triggered protest from a group of current hospital staff, who criticised the ‘crazy’ doctor of destroying the hospital’s fame and demanded the hospital to expel her. The doctor and the hospital went into law suit for years and it ended with the victory of the hospital in 2016. However, debates surrounding the case continue.
- 19.
The use of a single media case here is because I cannot find more proper case from my field. However, the views and ideas expressed by this case and the following analysis are inspired by and in accordance with the views expressed by the health professionals in my field. This incident happened in the neighbouring municipality of Riverside. When this incident happened, I communicated with the health professionals in my field (who I still kept in contact) through internet, they expressed that similar incidents had happened in Riverside County too, but I could not get complete information about these similar cases because I already left the field. Besides, media reports sometimes provide compelling ‘raw’ accounts of traumas and tragedies of individuals, some of which may not be witnessed by researchers, such as the case I used here.
- 20.
In Chins, over 90% of outpatient and inpatient visits occurred in public hospitals in 2010, and 90% of health professionals were employed in the public sector (cited from Yang 2017: 13).
- 21.
Yan’s research (1996) on gifting in a rural village in China also finds that gift receiving rather than gift giving is regarded as a symbol of prestige, thus serves the hierarchy, in contrast to previous studies in other societies that find it was the giver who gains prestige and power by transforming the gift-receiver into a debtor.
- 22.
Other researches also find that the Chinese media frequently put blame on low-level cadres, which diverted attentions away from high-ranking party officials and the central government (see He 2000; Zhang 2006). Murphy (2007)’s research on the party education campaigns notes that the campaigns deflect systemic critique and blame the problems of corruption on the ethical misbehaviour of individuals; the party-state instead champions itself as the defender in the crusade against failed individual ethics.
- 23.
Such as the one released by Sichuan province in 2004 that specifies the punishment of health professionals who take ‘red-packet’ or kickbacks (see Sichuan Government 2007).
- 24.
References
Andaya, Elise. 2009. The Gift of Health: Socialist Medical Practice and Shifting Material and Moral Economies in Post-Soviet Cuba. Medical Anthropology Quarterly 23 (4): 357–374.
Bloom, Gerald, Leiya Han, and Xiang Li. 2001. How Health Workers Earn a Living in China. Human Resources for Health Development Journal 5 (1–3): 25–38.
Cai, Huiqun. 2013. “Crazy” Doctor: You Ruin the Hospital’s Reputation, the Hospital Will Make You Lose Your Job (‘Fengzi’ yisheng, ‘ni za yiyuan zhaopai, yiyuan za ni fanwan’). Southern Weekly (Nanfang Zhoumo). Retrieved 1 June 2013. http://www.infzm.com/content/90898.
Central People’s Government, PRC. 2013. Why Only 10% Patients Trust in Doctors—Members of CPPCC Pay Attention on Doctor-Patient Conflict (Weihe jin 10% huanzhe xinren yisheng – daibiao weiyuan guanzhu yihuan maodun). Retrieved 26 Aug 2013. http://www.gov.cn/2013lh/content_2349189.htm.
Chau, Adam. 2005. Miraculous Response: Doing Popular Religion in Contemporary China. Stanford, CA: Stanford University Press.
Cheal, David. 1988. The Gift Economy. London: Routledge.
Crouch, Colin. 2013. Making Capitalism Fit for Society. Polity Blog. Retrieved 6 Sept 2013. http://www.politybooks.com/blog/post.aspx?id=210.
Economist. 2012. Health-care Reform: Heroes Dare to Cross. Retrieved 22 July 2012. http://www.economist.com/node/21559379.
Fan, Ruiping. 2010. Reconstructionist Confucianism: Rethinking Morality after the West. London: Springer.
Giddens, Anthony. 1994. Living in a Post-Traditional Society. In Reflexive Modernization: Politics, Tradition and Aesthetics in the Modern Social Order, ed. U. Beck, A. Giddens, and S. Lash, 56–109. Stanford, CA: Stanford University Press.
Gregory, Chris A. 1982. Gifts and Commodities. London: Academic Press.
Guo, Sufang, Sabu S. Padmadas, Zhao Fengmin, James J. Brown, and R. William Stones. 2007. Delivery Settings and Caesarean Section Rates in China. Bulletin of the World Health Organization 85 (10): 755–762.
He, Zhou. 2000. Chinese Communist Party Press in a Tug-of-War. In Power, Money, and Media: Communication Patterns and Bureaucratic Control in Cultural China, ed. C. Lee. Evanston, 112–151. IL: Northwestern University Press.
Hui, Edwin C. 2010. The Contemporary Healthcare Crisis in China and the Role of Medical Professionalism. Journal of Medicine and Philosophy 35 (4): 477–492.
Kornai, Janos. 2000. Hidden in an Envelope: Gratitude Payments to Medical Doctors in Hungary. In The Paradoxes of Unintended Consequences, ed. R. Dahrendorf and G. Soros, 195–214. Budapest: Central European University Press.
Ledeneva, Alena V. 1998. Russia’s Economy of Favours: Blat, Networking and Informal Exchange. Cambridge, UK: Cambridge University Press.
Lei, Hui-zhong, S.W. Wen, and M. Walker. 2003. Determinants of Caesarean Delivery Among Women Hospitalized for Childbirth in a Remote Population in China. Journal of Obstetrics and Gynaecology Canada 25 (11): 937–943.
Levi-Strauss, Claude. 1969. The Elementary Structures of Kinship. Boston: Beacon Press.
Levy, Richard. 2002. Corruption in Popular Culture. In Popular China: Unofficial Culture in a Globalizing Society, ed. E. P. Link, R. P. Madsen, and P. G. Pickowicz, 39–56. Lanham, MD: Rowman and Littlefield.
Li, Peiling, and Su Wenqiao. 1997. An Ethical Analysis of Red Packet Phenomenon (Hongbao xianxiang zhi lunli fenxi). Chinese Medical Ethics (Zhongguo Yixue Lunlixue) 6: 51–52.
Lumbiganon, Pisake, A. Malinee Laopaiboon, Metin Gülmezoglu, João Paulo Souza, Surasak Taneepanichskul, Pang Ruyan, Deepika Eranjanie Attygalle, et al. 2010. Method of Delivery and Pregnancy Outcomes in Asia: The WHO Global Survey on Maternal and Perinatal Health 2007–08. The Lancet 375 (9713): 490–499.
Mauss, Marcel. 1954. The Gift: The Form and Reason for Exchange in Archaic Societies. London: Norton.
Mi, Jie, and Fangchao Liu. 2014. Rate of Caesarean Section is Alarming in China. The Lancet 383 (9927): 1463–1464.
Ministry of Health, PRC. 2004. The Ministry of Health’s Advice on Strengthening the Construction of Health Industry’s Working Style (Weishengbu guanyu jiaqiang weisheng hangye zuofeng jianshe de yijian). Retrieved 21 Dec 2014. http://wsb.moh.gov.cn/mohjcg/s3577/200903/39740.shtml.
Ministry of Health, PRC. 2012. Guidance on Strengthening the Prevention and Control of Corruption in Public Medical Institutions (Guanyu jiaqiang gongli yiliaojigou lianjie fengxian fangkong de zhidao yijian). Retrieved 21 Dec 2014. http://wsb.moh.gov.cn/mohjcg/s3577/201209/55937.shtml.
Murphy, Rachel. 2007. The Paradox of the State-run Media Promoting Poor Governance in China: Case Studies of a Party Newspaper and an Anticorruption Film. Critical Asian Studies 39 (1): 63–88.
National Health and Family Planning Commission, PRC. 2014. The Notice by NHFPC about Doctors and (In)patients should Sign an Agreement to Reject Red-packet (Guojia weisheng jisheng wei bangongting guanyu kaizhan yihuan shuangfang qianshu bushou he busong hongbao xieyishu gongzuo de tongzhi). Retrieved 13 May 2014. http://www.nhfpc.gov.cn/yzygj/s3577/201402/b7f939aeaeee41c28ba80023b74c4187.shtml.
Pei, Minxin. 2008. Fighting Corruption: A Difficult Challenge for Chinese Leaders. In China’s Changing Political Landscape: Prospects for Democracy, ed. C. Li, 229–250. Washington, DC: Brookings Institution Press.
People’s Net. 2013. Seven Doctors in Baotou Received Large Amounts of Drug Kickback being Arrested. Retrieved 14 Apr 2013. http://legal.people.com.cn/n/2013/0413/c188502-21123200.html.
Polanyi, Karl. 1944. The Great Transformation. New York: Rinehart.
Qiu, Renzong. 2006. To Discuss the Conceptual and Ethical Issues of Commercial Bribery in Medicine (Lun yixue zhong shangye huilu de gainian he lunli wenti). Medicine and Philosophy (Yixue yu Zhexue) 27 (10): 1–4.
Rivkin-Fish, Michele. 2005. Bribes, Gifts and Unofficial Payments: Rethinking Corruption in Post-Soviet Russian Health Care. In Corruption: Anthropological Perspectives, ed. D. Haller and C. Shore, 47–64. London: Pluto Press.
Scott, James C. 2008. Weapons of the Weak: Everyday Forms of Peasant Resistance. New Haven, CT: Yale University Press.
Sichuan Government. 2007. The Accountability System of Medical Institution Staff who Accept Red-packet and Kickback in Sichuan Province (Sichuan shen yiliaojigou gongzuo renyuan shoushou hongbao, huikou zeren zhuijiu banfa). Retrieved 20 Apr 2013. http://www.sc.gov.cn/hdjl/jfgz/zxzl/bzzf/200702/t20070212_174973.shtml.
Simmel, Georg. 1978. The Philosophy of Money. London: Routledge & Kegan Paul.
Stan, Sabina. 2012. Neither Commodities Nor Gifts: Post-Socialist Informal Exchanges in the Romanian Healthcare System. Journal of the Royal Anthropological Institute 18 (1): 65–82.
Tu, Jiong. 2010. Privatisation of Health Care in Transitional China: A Study of Private Clinics at the County Level. Master thesis, Tema Health and Society, Linköping University. Retrieved 7 Apr 2013. http://liu.diva-portal.org/smash/record.jsf?pid=diva2%3A325266&dswid=6634.
Tu, Jiong. 2014. Encountering Chinese Officials: Bureaucratism, Politics and Power Struggle. LSE Field Research Method Lab. Retrieved 12 Dec 2014. http://blogs.lse.ac.uk/fieldresearch/2014/10/21/encountering-chinese-officials/.
Uretsky, Elanah. 2016. Occupational Hazards: Sex, Business, and HIV in Post-Mao China. Stanford: Stanford University Press.
Wang, Hongxia. 2005a. Analysis of the Red Packet Phenomenon in the Medical Field (Yiwujie hongbao xianxiang de zhengce duice). Chinese Medical Ethics (Zhongguo Yixue Lunlixue) 18 (3): 11–13.
Wang, Wenjun. 2005b. The Legal Liability of the Physicians Receiving Red Packets and Kickbacks (Yishi shouqu hongbao, huikou (ticheng) de falv zeren). Medicine and Philosophy (Yixue yu Zhexue) 26 (12): 52–53.
Wank, David. 2001. Commodifying Communism: Business, Trust, and Politics in a Chinese City. Cambridge, UK: Cambridge University Press.
Xinhua Net. 2004. Receiving 500 Yuan Red-packet, A Doctor in Sichuan was Dismissed. Retrieved 14 Apr 2013. http://news.xinhuanet.com/newscenter/2004-06/22/content_1539516.htm.
Xinhua Net. 2012. Jiangxi Gaoan: Doctor Who Refused Red-Packet Being Attacked, Doctor-Patient Relationship Being Questioned (Jiangxi Gaoan: yisheng jushou hongbao beida, yihuan guanxi zai zhao ‘kaowen’). Retrieved 5 Oct 2013. http://www.jx.xinhuanet.com/news/focus/2012-07/30/c_112574325.htm.
Xinhua Net. 2013. “Only 10% Patients Trusted in Doctors” is a Serious Warning (Jin 10% huanzhe xinren yisheng shi ji chenzhong jingzhong). Retrieved 26 Aug 2013. http://news.xinhuanet.com/health/2013-03/11/c_124442435.htm.
Yan, Yunxiang. 1996. The Flow of Gifts: Reciprocity and Social Networks in a Chinese Village. Stanford, CA: Stanford University Press.
Yang, Mayfair Mei-hui. 1989. The Gift Economy and State Power in China. Comparative Studies in Society and History 31 (1): 25–54.
Yang, Mayfair Mei-hui. 1994. Gifts, Favors, and Banquets: The Art of Social Relationships in China. Ithaca, NY: Cornell University Press.
Yang, Jingqing. 2008. The Power Relationships Between Doctors, Patients and the Party-State Under the Impact of Red Packets in the Chinese Health-Care System. Ph.D. dissertation, Department of Social Science and International Studies, University of New South Wales. Retrieved 9 Apr 2010. http://handle.unsw.edu.au/1959.4/43116.
Yang, Jingqing. 2017. Informal Payments and Regulations in China’s Healthcare System: Red Packets and Institutional Reform. Singapore: Springer.
Yurchak, Alexei. 2002. Entrepreneurial Governmentality in Post-Socialist Russia: A Cultural Investigation of Business Practices. In The new entrepreneurs of Europe and Asia, ed. V. Bonell and T. Gold, 278–324. Armonk, NY: ME Sharpe.
Zhan, Mei. 2013. Human Oriented? Angels and Monsters in China’s Health Care Reform. In Health Care Reform and Globalisation: The US, China and Europe in Comparative Perspective, ed. P. Watson, 71–92. London: Routledge.
Zhang, Xiaoling. 2006. Reading Between the Headlines: SARS, Focus and TV Current Affairs Programmes in China. Media, Culture and Society 28 (5): 715–737.
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Tu, J. (2019). Gift Practice in the Chinese Health Sector: Inequality, Power and Governance. In: Health Care Transformation in Contemporary China . Springer, Singapore. https://doi.org/10.1007/978-981-13-0788-1_5
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