正式纠纷解决制度失效、牟利激励与情感触发——多重面相中的“医闹”事件及其治理  

Professionalism, Money or Emotion: Understanding Disruptive Incidents in Medical Disputes and Related Governance in China

作　　者：张晶[1] 

机构地区：[1]东南大学人文学院,南京211189

出　　处：《公共管理学报》2017年第1期61-74,共14页Journal of Public Management

基　　金：教育部国家社科基金青年项目(12CSH013)

摘　　要：我国频发的"医闹"事件引起了广泛学术关注,但是少有研究从中观层次讨论"医闹"事件形成的影响因素。本文借用抗争研究范式,从资源视角、替代性机制视角、情感视角三个视角讨论了"医闹"参与者的行为逻辑。统计资料和个案研究表明,"医闹"的形成受多重影响。首先,正式制度专业化纠纷解决能力的高低与患者"医闹"的概率呈负相关关系;其次,患者的求偿意愿与"医闹"事件发生的概率呈正相关关系;再次,患者在医疗纠纷中的情绪因素会显著影响"医闹"事件的发生。中国"医闹"事件中的患方需求可划分为经济性诉求、伦理性诉求和情感性诉求,通过刚性治理和法律治理的医疗纠纷解决途径重经济性诉求,轻伦理性和情感性诉求,偏重于解决集体型"医闹",因而难以遏制个体型"医闹"。由第三方社会组织主导的"柔性治理"模式或可提供由国家到社会的冲突治理新思路。With the deepening of marketization trends in medical profession in recent years, severe medical disputes between patients and hospitals have been increasing in China. In some the medical disputes,patients tend to employ disruptive behaviors(or 'yinao' in Chinese),especially the collective violent behaviors to go against the hospitals, destroying the medical and social order.This paper tries to provide explanations of occurrence of 'yinao' incidents from contentious politics. Based on one-year intensive field work, interview with more than 30 related patients, physicians and mediators, as well as a first-hand data set of more than 800 medical disputes(probably the most informative original data set of medical disputes in China), this study demonstrates that the escalations of medical disputes in China have been influenced by factors from three dimensions. First of all, the limited professional capacity of agents in the institutionalized approaches increases the probability of occurrence of 'yinao'. Specifically, high-class hospitals with stronger capacity of profession tend to contain the physician-patients conflicts and reduce the probability of escalations of medical disputes. Medical disputes which cannot be identified or distributed the responsibilities are more likely to escalate into disruptive incidents. Secondly, the incentive of making money through medical disputes resolution encourage patients' use of disruptive strategies. The local governments tend to constantly employ the 'buying stability' tactics to resolve the medical disputes and to appease the patients. Thus, patients with more stronger economic demands are more likely to employ disruptive tactics in medical disputes. Thirdly, specific kinds of medical disputes triggering patients' emotions tend to increase probability of disruptive actions of patients. Medical disputes causing acute and severe injury are more likely to result in the patients' disruptive behavior,especially the collective violent behaviors mobilized through individual or family

关 键 词：“医闹” 维权 多重需求 柔性治理 

分 类 号：C912[经济管理]