Meaning of patient involvement and participation in Chinese hospitals
Increased patient involvement and participation in health care is embraced by researchers and practitioners due to the benefits of improving health outcomes and safety, reducing cost and enhancing a democratic relationship between service providers and users. Patient preferences and views are regarded valuable in the delivery of health care. However, the meaning of patient involvement and participation, particularly the willingness for involvement, changes from context to context, depending on the positions or circumstances patients occupy. In addition, the meaning of patient involvement and participation is likely to be affected by wider contexts, such as meso-level and macro-level contexts. Yet, the association between the meaning of involvement and contexts has been underdeveloped in the literature. Although there are a range of studies exploring the determining factors of patients’ desire for involvement at the clinical level and discussing the issue within a particular context, it needs a comprehensive and systematic analysis of political, policy, institutional, individual, cultural and social contexts. Meanwhile, as most of the previous studies focus on mature and publicly-funded health systems, it remains unknown what patient involvement and participation means in other health systems. In this regard, the study focuses on China, a new context with a non-publicly funded and developing health system, which provides a unique case to develop the new knowledge of patient involvement and participation. A fundamental question is addressed in the study: What does patient involvement and participation mean in Chinese hospitals? To explore the taxonomy of patient involvement and participation and the contextualised factors that are likely to affect the willingness of service users in health care delivery, I adopt a three-case design with three local hospitals in Shandong Province, an eastern province of China. I use the abductive research strategy to generate emergent hypotheses in the first stage of fieldwork and test deductively in the second stage. Qualitative methods are used for data collection, including individual interviews and policy documents. Interviews involve a range of stakeholders, including service users, professionals, health board managers and local administrators. The evidence in East China demonstrates that the macro-level and meso-level contexts play a crucial role in affecting users’ willingness for involvement, including political, policy and institutional contexts, as well as economic and socio-demographic conditions. Marketisation and consumerism, professionalism, the absence of political participation and the limited development of civil society are all contributors to the willingness for involvement. The lack of policy support, the current institutional design of user involvement, different organisational autonomy and resources, and the demography of the population of service users significantly affect how much service users wish to be involved. Meanwhile, a range of individual contexts are identified to significantly affect how Chinese service users wish to be involved in their health care, including health insurance type, socio-demographic characteristic and disease-type. Cultural context and family influence also matter. The social capital, seriousness of condition and the stage of condition are likely to affect the demand for involvement. Through the lens of various stakeholders, I examine the barriers to patient involvement and participation in China and proceed to a further theoretical discussion of co-production in health care.