Dignity in the Red Envelope: The Culture Work in Informal Payments for Medical Services in China

• In Event: 3184 - Section on Sociology of Culture Refereed Roundtable Session
  In Refereed Roundtable 100min: Table 07. Culture, Economy, and Organizations

Abstract

This paper examines the informal transactions occurring in the field of public healthcare in China with a cultural and interactionist approach. Informal transactions refer to the transactions in which patients exchange money, gifts, or favors for assurance of better medical care from doctors. Drawing on interviews with 18 patients and 32 doctors, we have identified four types of transactions (“Quick Fix”; “Face and Power”; “Fair Dealing”; and “Bao”), which respectively represent expedient exchange, authoritative exchange, economic transaction, and affective reciprocity. We have also shown that both doctors and patients engage in various ways of “culture work” to justify the otherwise morally dubious transactions. The paper also shows that, although both doctors and patients possess a set of toolkits that contain four similar types of discourse in terms of giving meanings to the informal transaction, there are still matches and mismatches between how doctors justify their acts of treating patients preferentially and how patients perceive such acts. The relational mismatches occur in all types of transactions except in “Fair Dealing”. “Quick Fix”, “Face and Power”, and “Bao” are considered as problematic by either doctors or patients, thus the transactions are not able to be made between the two sides. Doctors and patients, however, manage to make the transaction by both agreeing that the exchange is an “economic transaction”. In other words, this paper reveals the hidden assumption behind a successful economic transaction: Only when people consider the exchange as an “economic transaction” are they able to make such a transaction, and as long as one side deems it as culturally or morally problematic, such an exchange will not happen smoothly. A larger paradox is that when certain culture “works” in the informal payment it exacerbates the unequal access to medical services.

Authors

• Weirong Guo, Emory University

• Bin Xu, Emory University