State and the sick role: a study of sick models in the pre-reform China

Abstract

This study revisited the sick role theory and proposed that the doctor–patient dyadic system be expanded to include state as a major actor to extend the applicability of the theory to other political systems. I argue that state not only exercises coercive power in the social control mechanism, but also practices persuasion in the socialisation mechanism. Drawing on evidence from China, the paper notes that the establishment of the state medicine in the 1950s and 1960s significantly changed illness behavioural patterns of the people covered by public health insurances. To counteract abuse of health insurance and secondary gains, the Chinese Party-state propagated official sick role expectations and norms through sick models—sick persons who thought and behaved as the Party-state expected. Two types of sick models were identified: the cooperative and the ‘defiant’. These models were propagated to serve the Party-state’s political and economic agenda.