Settling Yinao in mainland China---communication digitization legislation

In recent years, significant progress has been made in Chinese health care. The
average life expectancy of the Chinese population increased from 35.2 (1949) to 76.1
(2016) and the maternal mortality rate dropped from 108.8 per million (1949) to
2.1per million (2016). (Zhou et al., 2017) However, the healthcare disturbance, or

tee-ien_e-t-wenonvince.cl
Yinao ,have been continuously rising in number.
According to the medical law published in 2018, Yinao can be defined as the act
that seriously disrupts medical order such as insulting and threatening medical staff ,
purposefully injuring medical staff or damaging public and personal property in
hospitals or even carrying guns, ammunition, restricted tools or hazardous items into
hospitals illegally. According to statistics from National Health and Family Planning
Commission of the people’s Republic of China (2001–2016), these events increased
from 4914 to 20,833 cases. (2016) (Zhou et al., 2017), having an adverse effect on the
whole society. To settle increasingly serious Yinao in China, improving the doctor’s
communication ability, perfecting the hierarchical medical system based on the big
data and consummating legal channels in the conflict resolution mechanism, could be
practical and conductive measures.
It is believed that Chines doctor–patient relationship has become more and more
tense in recent years coming to “irreconcilable edge ". (Zhang et al., 2011) Statistics
from National Health and Family Planning Commission of the People’s Republic of
China (2001–2016) shows that 1807 health care workers hurt by patients in the year
of 2001, increasing to 8537 persons in 2016; hospital property losses of CN¥54.1
million (US$8.2 million) in the year of 2001 increasing to CN¥304.7 million
(US$43.5 million) in 2016. More striking is one survey collected the data of 326
hospitals nationwide by Chinese Hospital Association, 98.4% had healthcare
disturbance in 2015. (Zhou et al., 2017)
The major causes of Yinao are multifaceted and interlinked. On the micro-level,
yinao is often triggered by misunderstanding, miscommunication and, more

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importantly, a lack of trust between patients and doctors. (Huang, 2020) Since
1978 China has gone through the healthcare reform, which means healthcare
industry adopted market-oriented operation mode directly resulting the decrease of
Chinese government’s investment in medical care. Cutbacks in government funding
for health care in the 1980s forced hospitals to become profit-minded to make up for
the vast financial shortfall (Hsiao, 1995). Lots of improper ways– especially revenue-
related bonuses – were introduced to motivate physicians to generate benefits from
patients’ pockets by providing over-treatment and over-prescription (Liu and Mills,
2003; Hsiao, 2008). Undeniably, such immoral acts of doctors are existed more or
less, but the media at that time has exaggerated healthcare reports and demonized the
images of doctors for sake of attention, further deepening mistrust between patient
and doctors. (Zhou et al., 2017)
Apart from that, the medical resources in many places especially the villages and
backward areas are quite inadequate causing the heavy work load for limited doctors.
Advanced medical equipment and skilled doctors are concentrated in large general
hospitals, in the most developed cities. Also, Only 1.3% of all medical facilities are
public hospitals, but they conduct more than a third of medical care. (Zhou et al.,
2017) A survey finds that in Zhe Jiang province ,60% of provincial hospital doctors
normally worked exceeding 60 hours a week with 23% working more than 30 hours a
week in overtime, on a ‘forced voluntary’ basis. (Wu et al., 2014) Under great
working stress, it’s difficult for doctors to spare enough time on each patient for rich
exchange of views with a nice service attitude. As statistic show the consultation time
spent with each outpatient is usually less than three minutes for Chinese doctors. (The
Lancet, 2014) In this way,the interactions between doctors and patients are extremely
brief and follow-up is rare .Frustrated with long waits, short appointments, and poor
attitudes, annoyed patients often resort to complaints or even violence to express their
discontent. (He & Qian, 2016)

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Meanwhile, on the macro-level, China’s legal system is inefficient and ineffective
at solving medical disputes . Once the disputes happens, patients tend to take their
claims to the street even resort to violence. The whole legal frame work governing
these disputes is ambiguous and changing . Also the judgements are always on the
basis of political considerations instead of following the law. (Huang,
2020)According to the Chinese Medical Association, more than 80% of medical
disputes nationwide are resolved by under-the-table settlement, a percentage
considerably higher than the US .That is because the availability of greater
compensation through non-legal ways, like violence , need much less time and
expense. (He & Qian, 2016)
Yinao not only destroy the relationship between doctors and patients, but them also
threaten the development of Chinese medical career. Fearing being sued, doctors
settings have been found adopting defensive behaviors to avoid potential litigation.
Defensive medicine has made no positive contribution to the quality of care but has
put tremendous pressure on health care budgets.(Hermer and Brody, 2010; Adwok
and Kearns, 2013) Moreover, one nationwide survey noted that only 26% of
physicians thought that their patients had faith in them, and 70.9% would change
another occupation given the opportunity, which undoubtedly makes worse of the
inadequate doctors and makes medicine a career to be avoided in mainland China,
greatly threatening the development of Chinese medical care.(Dong et al ,2013)
To tackle the problem, improving the doctor’s communication ability through some
training can be an alternative way. Communication is a healthy dose for mending the
fences. It is reported that 75% of the orthopedic surgeons surveyed believed that they
communicated satisfactorily with their patients, but only 21% of the patients reported
satisfactory communication with these doctors. (Tongue et al.,2005) However,
Doctors are not born with excellent communication skills. Instead they can
understand the theory of good doctor-patient communication, learn and practice these
skills, and be capable of modifying their communication style if there is sufficient
motivation and incentive for self-awareness, self-monitoring, and training.(Lee et
al.,2002) Effective communication is beneficial to help settle patients' emotions,
facilitate comprehension of medical information, and identify clearly patients' needs,
perceptions, and expectations. In this way, on the one hand the communication skill
training can be easy to carry out, which is relatively practical and directive. On the
other hand, the measure doesn’t address the problem from the root. Solving problems
only from doctors’ angle is obviously inadequate.
Additionally, another feasible measure could be perfecting the hierarchical medical
system based on big data. By using big data and mobile internet, the reformation can
relatively make full use of current medical resources regardless of the funding
shortage to reduce Yinao owing to the limited resources. If medical data can be
recorded and shared among health facilities at different levels, the transmittal of
patient’s information to medical service providers in different institutions could be
achieved resulting in patients being able to receive continuous medical services
 without going to “big hospital” to receive care. Doctors at more advanced hospitals
can take part in the medical activities of lower-level hospitals online and help medical
professionals in primary medical institutions to improve the quality of their services
(Wang et al., 2017)

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Nevertheless, it proposes higher demand of information security and privacy
protection, which could be a great concern.
However, consummating the legal channels in the conflict resolution mechanism
could be the ultimate approach. Unlike many other countries in the world, China has
no sound legal health care complaint system to mediate doctor-patient relationship.
Most patients cannot afford the cost and time required to utilize formal medical
dispute solutions, then may lead to violence against doctors. (Hesketh et al., 2012) So
it is imperative for government to provide an independent third party to assess
medical malpractice and perfect the framework of medical law to deal with Yinao.
(Xiang et al., 2011)On the one hand, Although the medical disturbance is written into
the Ninth Amendment to Criminal Law as a serious offense against medical order, the
modest and restrained guideline should be obeyed that, only when civil and
administrative laws fail to solve problems can criminal law be used. On the other
hand, traditionally, the administrative mediation of medical disputes is controlled or
manipulated as somewhat mandatory which is less receptive from the patients’ points
of view. therefore, setting up a designated third-party dispute resolution tribunal for
medical disputes not only promotes the communication of both sides but also prevents
the violence happening from the root.(Hu,2017)
In conclusion, Yinao reflects essentially reflects the lack of medical resources and
incomplete legal system in China. By improving the doctor’s communication ability,
perfecting the hierarchical medical system based on the big data and consummating
legal channels in the conflict resolution mechanism, the disputes between doctors and
patients can be addressed more properly,the future of Chinese medical health career
will be more promising.

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Reference list:
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