The relationship between the state and its professions has long been overlooked in the sociology of professions. Based on empirical data collected by in-depth interviews and through participant observation in Beijing, this thesis analyzed the dynamic relationship between Chinese urban medical professionals and the post-socialist state of the People’s Republic of China. The study reveals that the post-socialist state continues to wield large influence in the social, economic and technical areas of this profession and retain tight controls despite being in an era of market transition. This control is principally realized through the current healthcare system. Public hospitals have monopolized healthcare delivery, which gives medical professionals little alternative but to become state employees. Practicing in public healthcare organizations and lacking “exit” opportunities, they are left with little to negotiate their working conditions with the state and thus have little corporate autonomy. The lack of corporate autonomy immediately leads to the erosion of their clinical autonomy. Because of the pressure of self-financing imposed by the state, clinical practitioners consequently induce patients to accept unnecessary and excessive medical care. When they make decisions in practice, revenue generation is often recognized as more important than serving patients. This is a major source of clinical autonomy erosion. In prioritizing profit-making, Chinese urban medical professionals are perceived by the public as an “unethical profession.”The mutual distrust and conflict between professionals and patients have increased significantly in recent years. To protect themselves from growing medical disputes and, sometimes, even violence, Chinese doctors have developed “defensive medicine” strategies in their practices and in their interaction with patients. This is yet another source of clinical autonomy erosion as self-protection becomes an important calculation in balance with their own medical competence and patients’ interests. The case of medical professionals in urban China challenges Freidson’s endogenous view of professional autonomy and his distinction between corporate and technical autonomy. It also questions the simple construction of conflicting relationships between the state and professionals. Rather, this dissertation finds that there is an exchange-like relationship between professionals and the state. Professionals are not simply losers in their interaction with the state, they do profit as well as they retain job security in market transition, earn considerable economic benefits through their practice, and are shielded by public hospitals in medical disputes even if they are punished by those hospitals. Doctors receive all these gains at the large cost however as they rarely enjoy professional autonomy, suffer from a negative public image, and become scapegoats for the problematic healthcare system and the state. At the end of this thesis, I provide suggestions for the ongoing reform of China’s healthcare system. These suggestions include liberating doctors through the development of private practice and strengthening supervision over doctors’ behavior while increasing financial support for public hospitals. / published_or_final_version / Sociology / Doctoral / Doctor of Philosophy

published_or_final_version / Community Medicine / Master / Master of Public Health

The changes in the health care system have been remarkable over the past decades, along with the rapid economic development of China. The overall living standard of rural residents has generally improved; however, health expenses still make up a large part of their annual expenditure. During the new reform period, the importance of the village doctor has been emphasized by many scholars, and yet there are few studies conducted from the perspective of interactions between health administration, village doctor and rural resident to discover the invisible factors that influence the delivery of the health care service. Thus, this study aims to explore the street-level bureaucracy within the rural health care sector and its impact on rural residents. Guided by the Street-level Bureaucracy Theory and its application in public agency research, this study explores street-level bureaucracy in the grassroots health care sector in terms of health care regulation and provision before and after the recent series of health care reforms, and evaluates its impact on rural residents by analyzing health equity in terms of health care access, and the actual working and living conditions of the village doctor were identified. Apart from the official statistical data from document analysis and internet resources, the voices and advice of village doctors and rural residents in Jiangsu Province were also obtained from in-depth interviews, which provided the qualitative information for this study. There are four findings. First, as a typical street-level bureaucrat in the grassroots sector, the working condition of the village doctor has become more stable and their discretionary control has been enhanced greatly after the reforms, due to the implementation of specific rules and regulations and the changes in payment methods; Second, despite the fact that many regulations have been put into effect, compared to the supervision of the health administration, the payment method plays a significant role in the promotion of service equity; Third, village doctors regard their social reputation as important as their income, for they live in a small community network. Although the role of village doctor has been emphasized in the new reform, improvements in health equity are still not obvious and have had limited effect; Fourth, the function of the village doctor is not fully utilized, even though the coverage of current health insurance in rural areas has been tremendously expanded in the past decade. Accordingly, policy implications regarding the understanding of the work and social environment of village doctors in rural areas, especially on the future exploration of their function related to further reforms, are identified in the final chapter. Additionally, the theoretical and practical significances of this study have also been presented. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Weight misperceptions are common in adolescents and doctors’ advice may help clarify these misperceptions. Few studies have examined how common physicians assess various weight-related factors, including physical measurements, lifestyle factors, and obesity-related medical risks, based on adolescents’ reports and patient characteristics that predict such assessments. Physicians’ weight comments were associated with weight perception in overweight patients, however, such association was unclear in non-overweight adolescents. Objectives: The present study aimed to 1) examine how common adolescents received weight-related factors from private practitioners; 2) identify factors associated with these assessments; 3) assess how common adolescents received weight comments from private practitioners; 4) examine the association of body weight comments by private practitioners with weight perception in adolescents, intention to do more non-exercise physical activity (NEPA), and perceived risk of chronic disease for being overweight. Methods: In the Hong Kong Student Obesity Surveillance (HKSOS) project, 33692 students (44.9% boys; mean age 14.8, SD 1.9 years) from 42 randomly selected schools completed an anonymous questionnaire. The students were asked whether in the past 12 months any private practitioner (or their nurses) had assessed their height, weight, waist circumference (WC), blood pressure (BP), body mass index (BMI), diet, and physical activity. Students were also asked to report any weight status comments received from private practitioners. Perceived risk of chronic disease for being overweight and intention to do more NEPA were also reported. Weight status was based on self-reported weight and height. Multiple imputation was used to replace missing values. Logistic (or ordinal logistic) regression was used to assess the association between student characteristics and assessment of each weight-related factor, and the association of weight comments with adolescent weight perception, perceived risk of chronic disease, and intention to do more NEPA. Results: Among 13283 students who had doctor consultations in the past 12 months, 37.9% received physical measurements or lifestyle enquiries, with weight (20.8%), height (16.8%) and blood pressure (11.5%) being the most common, followed by diet (8.1%), BMI (6.3%), WC (4.6%), and physical activity (4.6%). In general, adolescents who were female, older, underweight or overweight/obese, had parents with higher education level, and had actively asked private practitioners for advice about weight were more likely to receive assessments of weight-related factors. Less than one-fifth (16.8%) of adolescents received height and weight or BMI assessments. Nearly 3 in 10 (28.7%) adolescents reported receiving weight status comments from private practitioners, of which 59.8% were correct. Correct weight status comments were associated with correct weight perceptions among adolescents regardless of weight status. Being told by a private practitioner that one is too fat was positively associated with perceiving higher risk of chronic disease for being overweight in normal weight and overweight adolescents, and more intention to do NEPA in all adolescents. Conclusions: Weight-related factors in adolescents were infrequently assessed by private practitioners in Hong Kong. Generally, unhealthy weight, higher parental education and advice-seeking by adolescents predicted these assessments. Receiving correct weight comments predicted correct adolescent weight perceptions. Practitioners should routinely assess and advise adolescents on weight status. / published_or_final_version / Community Medicine / Master / Master of Philosophy

abstract / toc / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy