{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T06:31:09Z","timestamp":1786516269098,"version":"build-2736575974"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Physician\u2013patient disputes (PPD) have been increasingly recognized as structural indicators of health system performance, yet they remain underexplored within universal health coverage (UHC) frameworks, particularly in the Chinese context. This study employed a mixed-methods approach integrating regulatory review and legal cases analysis, revealing that the regulatory framework for PPD has evolved from fragmented arrangements toward a more integrated civil, criminal, and administrative system, encompassing three stages: ex ante prevention, in-process management, and ex post dispute resolution and sanctioning. We analyzed 4,243 physician\u2013patient disputes cases (2015\u20132025), comprising 4,086 civil, 56 criminal, and 101 administrative cases. A marked decline was identified in publicly available dispute cases after 2019. This decline was temporally associated with major regulatory reforms and the COVID-19 pandemic, although the descriptive design of this study does not establish strong causation. The underlying structural drivers remain unresolved: 51.3% of civil cases arose from patients' subjective perception of care failure rather than confirmed clinical fault, may point to a systemic deficit in physician\u2013patient communication. Criminal cases were disproportionately associated with critical illness and high financial burden, suggesting that incomplete financial protection may contribute to extreme forms of physician\u2013patient conflict. Over 91.7% of all disputes were concentrated in tertiary hospitals, reflecting potential structural imbalances in resource distribution. This study suggests that PPD may be a form of institutional risk transfer originating from systemic deficiencies within the UHC framework. Legal governance alone may not be sufficient to achieve UHC goals; effective system performance ultimately depends on trust, equity, and accessibility within the health system. Future policy may consider strengthening security measures in high-risk departments, improving financial protection for high-cost conditions, developing communication-support roles, strengthening family doctor services at lower-level institutions, and testing patient engagement mechanisms to support shared decision-making.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1902179","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:56:56Z","timestamp":1786514216000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From regulation to real legal cases: physician\u2013patient disputes as a lens on universal health coverage governance in China, 2015\u20132025"],"prefix":"10.3389","volume":"14","author":[{"given":"Hong","family":"Pan","sequence":"first","affiliation":[{"name":"The Second People\u2019s Hospital, Wuhu Hospital, East China Normal University","place":["Wuhu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanlin","family":"Meng","sequence":"additional","affiliation":[{"name":"School of Philosophy and Law and Political Science, Shanghai Normal University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohar","family":"Lederman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, LKS School of Medicine, The University of Hong Kong","place":["Hong Kong, China"]},{"name":"Centre for Medical Ethics and Law, The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weitong","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Philosophy and Law and Political Science, Shanghai Normal University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingqiao","family":"Song","sequence":"additional","affiliation":[{"name":"Centre of Genomics and Policy, Faculty of Medicine and Health Science, McGill University","place":["Montreal, QC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"B1","unstructured":"Universal Health Coverage (UHC).\n          \n          2025"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1001731","DOI":"10.1371\/journal.pmed.1001731","article-title":"Monitoring progress towards universal health coverage at country and global levels","volume":"11","author":"Boerma","year":"2014","journal-title":"PLoS Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"l2349","DOI":"10.1136\/bmj.l2349","article-title":"What can we learn from China's health system reform?","volume":"365","author":"Meng","year":"2019","journal-title":"BMJ."},{"key":"B4","unstructured":"People's\n              Daily\n            \n          \n          The Annual Enrollment Rate for Basic Medical Insurance has Remained Stable at Around 95%, with Over 1.33 Billion People Enrolled\u2014Weaving the World's Largest Healthcare Safety Net\n          \n          2024"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the Sustainable Development Goals Era: time for a revolution","volume":"6","author":"Kruk","year":"2018","journal-title":"Lancet Glob Health."},{"key":"B6","unstructured":"Beijing\n          National Health Commission of the PRC\n          Bulletin (Issue No. 51): Summary of Research on Universal Health Coverage\n          \n          2019"},{"key":"B7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1093\/jmp\/13.3.277","article-title":"Medicine\u2014the art of humaneness: on ethics of traditional Chinese medicine","volume":"13","author":"Qiu","year":"1988","journal-title":"J Med Philos."},{"key":"B8","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1136\/jme.25.4.315","article-title":"Ancient Chinese medical ethics and the four principles of biomedical ethics","volume":"25","author":"Tsai","year":"1999","journal-title":"J Med Ethics."},{"key":"B9","first-page":"7","article-title":"On the system of medical ethics in ancient China and its contemporary significance","volume":"43","author":"Chen","year":"2022","journal-title":"Med Philos."},{"key":"B10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1111\/dewb.12169","article-title":"The crisis of patient-physician trust and bioethics: lessons and inspirations from China","volume":"18","author":"Nie JB Li","year":"2018","journal-title":"Dev World Bioethics."},{"key":"B11","unstructured":"Explanation of the Regulation on the Prevention and Handling of Medical Disputes\n          \n          2018"},{"key":"B12","unstructured":"Regulation on the Handling of Medical Accidents. Order No. 351 of the State Council.\n          \n          2002"},{"key":"B13","volume-title":"Law of the People's Republic of China on Basic Medical and Health Care and the Promotion of Health","year":"2020"},{"key":"B14","volume-title":"Civil Code of the People's Republic of China (Articles 1218-1228)","year":"2020"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1831405","DOI":"10.3389\/fpubh.2026.1831405","article-title":"Practical dilemmas and communication reconstruction of patients' right to informed consent under the Civil Code","volume":"14","author":"Chen","year":"2026","journal-title":"Front Public Health."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2648262","DOI":"10.1080\/23288604.2026.2648262","article-title":"Framing overtreatment as consumer fraud: analysis and implications of China's first civil public interest litigation in healthcare","volume":"12","author":"Jiang","year":"2026","journal-title":"Health Syst Reform."},{"key":"B17","volume-title":"Criminal Law of the People's Republic of China (2024 Amendment) (Articles 232, 234, 290, 293)","year":"2024"},{"key":"B18","year":"2018","journal-title":"Regulation on the Prevention and Handling of Medical Disputes, Order No. 701 of the State Council of the People's Republic of China"},{"key":"B19","first-page":"175","article-title":"The theoretical logic and institutional framework of administrative adjudication in resolving medical disputes","volume":"26","author":"Liu","year":"2025","journal-title":"J Nanjing Univ Chin Med."},{"key":"B20","unstructured":"Liu\n              C\n            \n          \n          Will Doctor-Patient Relations Remain Strong in the Post-Pandemic Era?\n          \n          2020"},{"key":"B21","first-page":"2260","article-title":"A study on the doctor-patient relationship in the context of COVID-19 treatment","volume":"10","author":"Wang","year":"2021","journal-title":"Adv Soc Sci."},{"key":"B22","first-page":"16","article-title":"Ethical reflections on information asymmetry in the doctor-patient relationship","volume":"18","author":"Qin","year":"2005","journal-title":"Chin J Med Ethics."},{"key":"B23","first-page":"1213","article-title":"A qualitative study on physicians' perceptions of shared decision-making between physicians and patients","volume":"25","author":"Yang","year":"2022","journal-title":"Chin Gen Pract."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.12677\/ojls.2024.124332","article-title":"Conflict and resolution of patient autonomy and physician discretion in advance care decisions","volume":"12","author":"Huang","year":"2024","journal-title":"Open J Leg Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"8408","DOI":"10.12677\/ACM.2023.1351177","article-title":"Reflections on a case of impaired clinical communication","volume":"13","author":"Liu","year":"2023","journal-title":"Adv Clin Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1111\/j.1475-6773.2010.01134.x","article-title":"Promoting health care equity: is health literacy a missing link?","volume":"45","author":"Hasnain-Wynia","year":"2010","journal-title":"Health Serv Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1111\/j.1475-6773.2006.00629.x","article-title":"Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature","volume":"42","author":"Karliner","year":"2007","journal-title":"Health Serv Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.ejmg.2018.12.004","article-title":"Effective communication in the era of precision medicine: a pilot intervention with low health literacy patients to improve genetic counseling communication","volume":"62","author":"Joseph","year":"2019","journal-title":"Eur J Med Genet."},{"key":"B29","doi-asserted-by":"publisher","first-page":"100162","DOI":"10.1016\/j.jmh.2023.100162","article-title":"Interpreter services and effect on healthcare: a systematic review of the impact of different types of interpreters on patient outcome","volume":"7","author":"Heath","year":"2023","journal-title":"J Migr Health."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e100","DOI":"10.1016\/S2214-109X(23)00499-0","article-title":"Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey","volume":"12","author":"Kruk","year":"2024","journal-title":"Lancet Glob Health."},{"key":"B31","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12961-018-0282-4","article-title":"Patient engagement in Canada: a scoping review of the \u2018how' and \u2018what' of patient engagement in health research","volume":"16","author":"Manafo","year":"2018","journal-title":"Health Res Policy Syst."},{"key":"B32","unstructured":"Southern Metropolis Daily Cancer Survey: Nearly Half of Patients Never Undergo Health Checkups; $300,000 in Treatment Costs Overwhelms Most Families\n          \n          2025"},{"key":"B33","unstructured":"How Much of Cancer Treatment Costs are Covered by Health Insurance?\n          \n          2025"},{"key":"B34","unstructured":"Statistical Bulletin on National Economic and Social Development of the People's Republic of China in 2025.\n          \n          2026"},{"key":"B35","first-page":"55","article-title":"An empirical analysis of key factors in judicial rulings on medical malpractice crimes in China and pathways for improvement","volume":"45","author":"Luo","year":"2024","journal-title":"Med Philos."},{"key":"B36","first-page":"126","article-title":"Governance mechanisms for doctor-patient disputes in contemporary China: current status, issues, and recommendations","volume":"3","author":"Xu","year":"2016","journal-title":"Chin Public Adm."},{"key":"B37","doi-asserted-by":"crossref","first-page":"140","DOI":"10.12677\/orf.2025.155238","article-title":"The impact of decentralizing medical resources on patients' healthcare choices in the context of tiered healthcare","volume":"15","author":"Chen","year":"2025","journal-title":"Oper Res Fuzziology."},{"key":"B38","article-title":"High healthcare costs and government expenditures in the context of \u201cHealthy China\u201d: an analysis from the perspective of structural imbalances in resource allocation","author":"Pang","year":"2024","journal-title":"J Xi'an Jiaotong Univ (Soc Sci)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e0171684","DOI":"10.1371\/journal.pone.0171684","article-title":"Patient experience with outpatient encounters at public hospitals in Shanghai: examining different aspects of physician services and implications of overcrowding","volume":"12","author":"Bao","year":"2017","journal-title":"PLoS ONE."},{"key":"B40","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3122\/jabfm.2016.02.150159","article-title":"Underuse of primary care in China: the scale, causes, and solutions","volume":"29","author":"Wu","year":"2016","journal-title":"J Am Board Fam Med."},{"key":"B41","first-page":"1917","article-title":"Current status and challenges of primary health care in China","volume":"27","author":"Qin","year":"2024","journal-title":"Chin Gen Pract."},{"key":"B42","unstructured":"Guiding Opinions on Promoting the High-quality Development of Contracted Family Doctor Services\n          \n          2022"},{"key":"B43","article-title":"Prevention and Handling of Medical Disputes","year":"2018"},{"key":"B44","article-title":"Basic Healthcare and Health Promotion Law of the People's Republic of China","year":"2020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1902179\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:56:59Z","timestamp":1786514219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1902179\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2026.1902179"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1902179","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1902179"}}