Analysis of current situation and influencing factor of medical disputes among different levels of medical institutions based on the game theory in Xiamen of China A cross-sectional survey

With continuous development of the Chinese health care system, the doctor-patient relationship is increasingly tense in recent years. China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This study aimed to help to theorize the doctor-patient relationship based on the game theory, and analyze the current situation and influencing factors for medical disputes among different hospitals. A total of 17 hospitals were randomly selected in Xiamen city, including 8 tertiary hospitals and 9 secondary hospitals. All medical dispute cases, between 2012 and 2014, were collected through questionnaires. Multiple logistic regression analyses were used to identify risk factors associated with medical disputes. In total, 896 medical dispute cases happened in 2012 to 2014, 733 (81.8%) of which occurred in tertiary hospitals. Medical disputes mainly were reported in the departments of obstetrics and gynecology (24.9%). The main causation of medical disputes was improper communication (24.0%) in tertiary hospitals and lower therapeutic skills (43.7%) in secondary hospitals, respectively. The negotiated rate (91.4%) in secondary hospitals was significantly higher than the tertiary hospitals (54.8%). The patients' age, occupation and the doctor's medical location, professional title were the main risk factors for the occurrence of medical violence. Relationships between doctors and patients have become worse increasingly, whereas doctor-patient disputes or conflicts and their compensation have aggrandized year by year. The game relationship of doctor-patient is noncooperation, dynamic, and incomplete information game, and the advantages of cooperation are far greater than the competition between doctors and patients. Therefore, we need to take targeted measures to prevent and control the medical disputes by establishing a harmonious doctor-patient relationship in different levels of medical institutions.