Structural Dilemma in Health System Reform in the Chinese Mainland and Emerging of Structure-Based Bioethics Paradigm

After reviewing the historical development of ethics and individual-based bioethics in Western countries, and comparing that in China, this paper starts from the extreme Beijing Tongren Case and the dilemma in the reform of health system in the Chinese mainland, and puts forward the topics of bioethics and medical professionalism under the circumstances of globalization, global health, and global health system reform. It compares the individual-based bioethics in Western countries and the structure-based bioethics in the Chinese mainland, and discusses the lessons of structure-based bioethics for other countries. The historical experience of health system reform in the Chinese mainland indicates that the health care system is welfare in nature, which is crucial; that the welfare health care system is the systematic foundation of medical professionalism; that there should not be direct economic interest generated in doctor-patient relationship since the marketization of health financing may lead to not only the structure intension of doctor-patient relationship, but also a total collapse of the medical professionalism. Therefore the Health Finance rather than Health Economics should be the material foundation of medical professionalism. The paper also points out that the main determinants of medical professionalism are not individual medical professionals, but the outcome of interaction between socio-cultural institutions and individual professionals, in which the sociality and structure are the most important components.