国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析

摘要/Abstract

摘要：

如何对医生的执业行为实施有效的社会控制是职业社会学的一个重要问题。本文通过对我国城市医生的执业环境与执业行为的分析，指出医生仍然依附于占据医疗服务市场垄断地位的公立医院，丧失法团自主性的他们无法与国家就收入与服务补偿进行协商。但也正是由于垄断地位，公立医院及其医生获得了对患者和医药厂商的双向支配地位，可以便利地将处方权转换为经济利益。但与此同时，医生对临床自主性的这种滥用意味着卫生行政部门的监管、职业规范内化后的自律等社会控制方式的失败。本文认为，医生这一职业群体在医疗卫生政策制定过程中的参与、逐步开放医生的执业自由以及给予非公立医疗机构平等的地位与待遇等措施会使这些问题得到改观。

关键词: 法团自主性, 临床自主性, 社会控制, 国家, 医生职业

Abstract:

Medical doctors enjoy a high degree of professional autonomy because of their highly specialized knowledge and skills that cannot be easily scrutinized by untrained outsiders. Thus,the question of effective social supervision of medical profession remains an important issue in sociology of occupations. This study compiles government statistics,existing literature as well as fieldwork data from Beijing public hospitals to provide an analysis of the working conditions and clinic practices of medical doctors in urban China. The study finds that Chinese medical professionals are dependent on public hospitals,the dominant healthcare delivery system in China. They have no corporate autonomy enabling them to negotiate with the state over working conditions,service compensations and salary. This resulted in a distorted market value of medical professionals. However,the monopoly of public health system places hospitals and physicians in a position of control over both patients and pharmaceutical companies,making possible for doctors to turn their prescription privilege into means for personal economic gains. "Red Envelops",kickbacks and over-prescriptions become standard compensations for doctors' state regulated relatively modest salaries. This abuse of clinical autonomy by medical professionals has been pervasive and persistent in China,a clear indication of not just the failure of the state supervision and regulation but also the failure of self-monitoring professionalism. The study suggests that reforms in ending the monopoly of public healthcare system,encouraging medical professionals' participation in policy decision making process,and allowing for private practice are some of the necessary steps to deal with the problem.

Key words: clinical autonomy, corporate autonomy, social control, the State, the medical profession

姚泽麟. 国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析[J]. 社会杂志, 2017, 37(2): 166-192.

YAO Zelin. State Control and Doctors' Abuse of Clinical Autonomy: An Empirical Analysis of Doctors' Clinical Practice in Chinese Public Hospitals[J]. Chinese Journal of Sociology, 2017, 37(2): 166-192.

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