Marketisation in China’s Health System: A Thematic Exploration of Impacts on Doctor-Patient Relationships

Background As a result of systemic reforms China’s healthcare system is now an uneasy mixture of state control and market mechanisms. Marketisation has not only reshaped healthcare delivery but has also fundamentally shifted the responsibilities of doctors and patients within the system. This paper reveals the increasing responsibilities borne by individual doctors and patients because of this trending. Methods This qualitative study involved thematic analysis of semi-structured interviews with 28 doctors and patients from various provinces in China. Participants were selected to represent diverse experiences within the health system. Thematic analysis was conducted to identify and interpret key patterns within the data. Results Three main dimensions of privatisation emerged from the analysis: accessing healthcare, care coordination, and healthcare financing. Findings indicate that marketisation has significantly increased the responsibilities placed on individual doctors and patients, effectively transferring systemic burdens to these individuals. Doctors face intensified pressures to manage care within fragmented health services, while patients confront greater personal responsibility in navigating access to care, coordinating their treatments, and handling healthcare expenses. These shifts exacerbate existing inequalities and complicate doctor-patient interactions. Conclusions The marketisation of healthcare responsibilities places significant burdens on both doctors and patients, transferring systemic responsibilities to individuals in access to healthcare. The concept of ‘privatised responsibilities’ offers a useful theoretical framework for further investigation of healthcare marketisation and its broader social implications. Based on these insights, we make policy recommendations aimed at defining more clearly the government’s role in ensuring equitable and accessible healthcare.