In recent years, China’s healthcare system has undergone profound transformations that are reshaping the fundamental dynamics between doctors and patients. A new study by Liu and Walker, published in the International Journal for Equity in Health, delves into these shifts, focusing on how doctor–patient responsibilities have evolved within China’s quasi-marketised healthcare framework. This system blends market logic with state intervention, creating unique challenges and opportunities that influence healthcare delivery and ethical considerations.
At the heart of this transformation is the introduction of quasi-market mechanisms designed to infuse competition and efficiency into a historically state-dominated healthcare environment. Unlike a purely privatized system, China’s quasi-marketised healthcare retains significant government oversight yet increasingly leverages market principles, such as performance-based payments and patient choice empowerment. Such mechanisms are intended to encourage hospitals and medical professionals to improve service quality and operational efficiency. However, this hybrid system also complicates traditional expectations of doctor–patient interactions, prompting a reevaluation of responsibilities on both sides.
Historically, the doctor–patient relationship in China was largely paternalistic, shaped by Confucian values emphasizing authority and respect for medical professionals. Patients tended to defer to doctors’ expertise without significant questioning or demands for shared decision-making. In contrast, the current reforms introduce pressures that encourage patients to be more engaged and assertive, while physicians face incentives to balance clinical care with economic considerations. This duality challenges conventional roles, with doctors navigating a complex terrain of clinical duty, institutional goals, and patient expectations.
One key aspect highlighted by Liu and Walker is the redefinition of doctors’ responsibilities in this evolving landscape. Physicians are not only expected to provide technically proficient care but are also increasingly accountable for patient satisfaction and service efficiency. The integration of financial incentives linked to patient outcomes and hospital revenues introduces new layers of responsibility that may affect clinical autonomy. This creates potential tensions between medical judgment and organizational priorities, raising concerns about the quality of care and ethical practice standards.
Simultaneously, patient responsibilities are being reconfigured. As healthcare markets open, patients in China are encouraged—and sometimes compelled—to take a more active role in managing their health. This includes engaging in informed consent processes, health literacy improvement, and navigating complex healthcare choices often influenced by cost considerations. While this empowerment aligns with global trends toward patient-centered care, it also assumes a level of health knowledge and economic ability that not all Chinese patients possess, potentially exacerbating inequalities.
The quasi-market system amplifies disparities rooted in socioeconomic status and geographic location. Rural populations and lower-income groups often face barriers in accessing and understanding healthcare options, limiting their ability to participate fully in the new doctor–patient dynamic. Liu and Walker’s analysis underscores the risk that market mechanisms, without robust safeguards, may deepen inequities and erode trust between patients and providers. Trust, historically a cornerstone of medical relationships, is vulnerable in a climate of commercialized care and shifting responsibilities.
Technology and digital health innovations play a pivotal role in this transformation as well. Telemedicine, electronic health records, and health apps facilitate greater patient engagement and provide new tools for diagnostic and therapeutic processes. However, these technologies also impose new responsibilities and expectations on both doctors and patients. Physicians must adapt to remote communication and data-driven decision-making, while patients are expected to manage digital platforms and protect their health information privacy—tasks that require digital literacy that is unevenly distributed.
Liu and Walker emphasize the ethical implications of these structural changes. The commodification of healthcare risks prioritizing profitability over patient welfare, challenging the traditional medical ethic of beneficence. Doctors face dilemmas in balancing commercial pressures with clinical integrity, navigating conflicts of interest, and maintaining professional standards amid competitive hospital environments. These tensions require nuanced policy responses and professional guidelines to safeguard ethical care delivery.
Another dimension is the fragmentation of responsibilities introduced by marketization. In the quasi-market framework, various actors—including hospitals, insurance providers, regulatory bodies, and individual physicians—share overlapping but sometimes conflicting duties. Coordination challenges arise, with potential for gaps in accountability and blurred lines of responsibility. Effective governance mechanisms and clear role definitions become paramount to ensure coherent and patient-centered care.
From the patient perspective, navigating this complex system is daunting. The expansion of choices and responsibilities demands higher levels of health literacy and financial acumen than were previously necessary. The diversity of providers and services, varying in quality and cost, complicates decision-making. Patients increasingly face the dual role of consumer and care participant, negotiating the tensions between health needs and economic constraints.
The authors also provide critical insights into the cultural shifts underpinning these changes. The rise of consumerism in healthcare, driven by market incentives and patient empowerment initiatives, contrasts sharply with traditional collectivist and hierarchical norms. This cultural transition fuels new expectations for transparency, communication, and participation in healthcare decisions. At the same time, it generates uncertainty and ambivalence among both doctors and patients adapting to redefined roles.
Policy implications stemming from this research are significant. To optimize doctor–patient interactions in China’s quasi-marketised system, reforms must address structural imbalances and ensure equitable access to information and care. Standardizing clinical protocols, enhancing health education, and strengthening regulation of market behaviors are critical steps. Policymakers must also consider mechanisms to realign financial incentives with patient-centered outcomes, minimizing conflicts of interest.
Furthermore, the study underscores the importance of professional development and support for physicians. Training programs should equip healthcare providers with skills to navigate the marketised environment without compromising ethical care. Communication, shared decision-making, and cultural competency become vital competencies. Supporting physicians’ well-being is equally important to mitigate burnout induced by conflicting responsibilities.
Looking ahead, the transformation of doctor–patient responsibilities in China offers lessons for healthcare systems worldwide grappling with market influences and patient empowerment. The delicate balance between efficiency, equity, and ethics requires continuous monitoring and adaptive governance. The Chinese experience demonstrates both the potential benefits of incorporating market dynamics and the risks of unintended consequences that can undermine trust and access.
In conclusion, Liu and Walker’s study provides a comprehensive exploration of how China’s quasi-marketised healthcare system is redefining the roles and responsibilities of doctors and patients. Their research combines sociological analysis with policy evaluation to illuminate complex interdependencies and challenges. As China advances its healthcare reforms, managing these evolving relationships will be crucial to fostering a system that is both efficient and equitable, responsive to the needs of all stakeholders.
Their findings amplify the need for a multidimensional approach to healthcare reform—one that integrates cultural sensitivity, technological innovation, ethical rigor, and structural coherence. Only through such a holistic perspective can the transformation of doctor–patient responsibilities support a sustainable, high-quality healthcare system in China and perhaps serve as a model for similar transitions elsewhere.
Subject of Research:
Transformations in the roles and responsibilities of doctors and patients within the context of China’s quasi-marketised healthcare system, focusing on the socio-economic, ethical, and policy implications of this evolving dynamic.
Article Title:
Transformations in doctor–patient responsibilities in China’s quasi-marketised healthcare system
Article References:
Liu, H., Walker, A. Transformations in doctor–patient responsibilities in China’s quasi-marketised healthcare system. Int J Equity Health 24, 313 (2025). https://doi.org/10.1186/s12939-025-02690-1
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12939-025-02690-1
