I. Social stratification Social stratification refers to a method of dividing members of society into a number of social groups of different levels and grades according to certain criteria, which vary according to scholars’ research purposes, so the results of stratification are also very different. But there is one thing in common, that is, the selection of this stratification criterion should be made so that there is a more obvious demarcation line between the various classes after the division, that is to say, the selection of social stratification criterion is based on the heterogeneity rather than the homogeneity of a certain aspect of the members of the society, because the existence of a large number of homogeneity of the members of the society loses the significance of the social stratification. In Western sociology, the first to put forward the theory of social stratification was the German sociologist Weber, who proposed a threefold criterion for dividing the structure of social classes, namely, the economic criterion – the amount of income and wealth, the political criterion – power, and the social criterion -prestige. Modern Western sociologists’ research on social stratification is basically based on Weber’s theoretical model of stratification, and some of the more representative models include the Weber-Werner model, the occupational stratification model of Parsons and Blau-Duncan, and the power stratification model of conflict theorists such as Dahrendorf. However, in order to simplify the method of social stratification, the mainstream view in the academic world nowadays tends to regard “occupation” as a criterion that includes information on the possession and use of various economic and social resources. Taking “occupation” as the criterion for social stratification, taking resource possession as the basic dimension, and attaching it to the measurement of the comprehensive index of socio-economic status, is also easier to connect with “common sense” and accepted by the general public. Contemporary Chinese society is divided into 10 tiers according to occupation: 1) state and social administrators, 2) managers, 3) private entrepreneurs, 4) professional and technical personnel, 5) clerical staff, 6) self-employed businessmen and businesswomen, 7) commercial and service employees, 8) industrial workers, 9) agricultural laborers, and 10) unemployed and semi-unemployed people. Second, the different manifestations of health-seeking behavior in social stratification To facilitate the exposition of health-seeking behavior, I summarize the above 10 layers into three major blocks of head, body, and tail, or the HBT model for short, which is shaped similarly to China’s economic situation model-the olive-shaped model. That is, the two heads are small and the center is large. The head includes:1,2,3 layers. The body includes:4,5,6,7,8 layers. The tail includes:9, 10 layers. But first of all, I declare that this social stratification does not have any class consciousness, nor does it have the meaning of personality distinction, only from the difficulty of seeking medical treatment roughly divided. The behavior of each layer of seeking medical treatment can be simply expressed as follows: the head is easy to seek medical treatment; the body B pressure to seek medical treatment; the tail is difficult to seek medical treatment. The head includes: state and social administrators, managers, and private entrepreneurs. This segment is always in a dominant position because they either directly or indirectly manage the medical staff (state and social administrators), or they give the medical staff benefits (managers, private entrepreneurs). They have become accustomed to privileges in medical treatment: no queues, free treatment, special services. Their medical behavior is the easiest. There are four ways to seek medical treatment: 1. Commanding: using the power in their hands, ordering medical personnel to give them medical treatment, mainly seen in the state and social administrators. This is a product of the legacy of feudal society in China. Have the right not to use, expired. They may not have much power, but they can make the most of it. As a medical worker, I oppose this kind of behavior from the bottom of my heart. Honestly, you are a patient when you are sick, so why are you always overbearing, pretending to understand and pointing fingers. I once met a patient with a one-ranking position. He was not seriously injured, only a distal radius fracture, but called the hospital office before he even came to the hospital. He should have been seen by a treating or attending physician, but the hospital office had to ask the director to see him. By the time the director arrived, he or she had endured unnecessary pain. It must be emphasized that the hospital office also knows that the director does not always do a good job, but to give the leadership psychological comfort. Only leaders comfortable, the masses can be comfortable! 2, passive: some physicians take the initiative to courtesies, the patient into a passive seek medical treatment. Where a bit of power of the leadership, not worried about no one to ask for warmth. China has a bad point, why do most of the technical want to be an official? They are willing to lose their personality in the face of power, they become uneducated, and they specialize in skulking around. These people are eventually purged from the medical team – turned into health officials and even government dignitaries. Because of the presence of these people, the active medical care of state and social administrators becomes passive. As a result, sometimes no illness becomes a minor illness and a minor illness becomes a major illness – and medical personnel sometimes use the ignorance of these people for their own purposes! I remember watching a movie a long time ago about a newly appointed mayor of a city who had abdominal pain because of a bad meal, and the doctors at the city’s People’s Hospital diagnosed the mayor with “acute appendicitis” after asking him a few questions and not daring to touch the mayor’s abdomen. The whole hospital discussed it (very seriously, but no one went to check the body) and immediately operated on it, with a deputy chief physician who needed to be promoted as the chief surgeon. As a result, the appendix was fine and had to be removed. The injection was given by a pretty nurse, and it didn’t hurt at all, because she simply just wiped her ass with a cotton ball and did the injection. Predictably, the mayor’s wound got infected and he ended up running to medical school himself to get it fixed. He didn’t know anyone at medical school, but got real medical treatment. 3. Money-bashing: Finding a physician to see a doctor through the use of red envelopes is mainly seen in managers and private business owners. With the advent of money worship, this trick often works well and even sometimes gets better medical care than state and social managers. For example, most of the physicians just want to be a physician, or to be precise in the political world when there is no hope, the government officials are also mostly superficial perfunctory, while the businessman is a smile accordingly, thoughtful and considerate, may get some benefits. Shenzhen doctors have such a kind of talk, the leaders came you can ignore, Chaozhou people came you can not ignore. Because most of the Chaozhou people are doing business, very rich! They also have more respect for physicians, because they envy the readers, unlike some government officials do not take physicians seriously. 4, friend style: know a few physician friends, fixed to find them to see a doctor. Many smart government officials always have a few very high level of physician friends, rather than through the intermediary to see a doctor. Some businessmen also have a few willing to work with the businessman as a physician friend. A phone call and a few text messages and the problem is solved. The visit may be at the dining room table or in a coffee shop. Most physicians would like to have a few social friends, not necessarily for their money or power, because this is a society of relationships. Physical Pressure to Seek Medical Care Physical pressure includes: professional and technical staff, clerical staff, self-employed workers, commercial service employees, and industrial workers. This piece is the main body of seeking medical treatment, have the basic conditions of seeking medical treatment, have the basic desire to seek medical treatment, have to seek medical treatment of the social environment. They do not have the superiority of the head, but they do not have the helplessness of the tail either. Their seeking medical treatment is natural, routine and understandable to common people. However, they are under certain pressure to seek medical treatment, which may be due to the failure of medical reform, the insufficiency of medical resources, or their own poor psychological quality. Their medical seeking behaviors are roughly of the following four kinds: 1. Formal style: Seeing the doctor and hospitalization through formal procedures, and accepting all medical services from medical staff. This kind of person is the mainstream of seeking medical treatment at present, is the so-called real citizens in today’s society – basically only care about the affairs of the state, not to participate in the affairs of the state. When they seek medical treatment, they think that if I spend money, you should give me service, but they will not be very demanding. As physicians, we respect such people from the bottom of our hearts and will serve them earnestly with the skills we have learned, but the relationship is limited to that of doctor and patient. Some patients may be tempted to make a little request that may not be in line with the policy, and after we sternly reject it, they understand and do not think about it any more. There are even some who tentatively ask the doctor, “Do you want to go out for a meal together?”. I think doctors in general would say, “No need.” This is the so-called “no need”. The doctor does not lack the money for the meal either! The medical services that such people get are the real services in the current medical market. I can assure you as a doctor that although you do not have a good friendship with your doctor, the service you receive is of equal value. Never think that if you don’t give red packets to doctors, how will it be – this is the misunderstanding of the society. 2. Excessive style: only the average person with the status of an average person wants to have the medical care of a first-class person. They may be an ordinary laborer, but demand to stay in a high-ranking ward, thus creating a disagreement with the head of the factory. They are supposed to have normal body nutrition, but demand high-grade drugs such as albumin – perhaps because a certain patient in the same ward is using it! This made the medical staff feel that he was in love with public favors. Perhaps they were a patient with a very mild condition but demanded special attention from the medical staff, which made the medical staff feel that he was annoying. Originally, the doctor thinks that they can be discharged, but they do not want to be discharged, just because they want to get more public injury benefits, which makes the medical staff feel that they are very badgering. Maybe this is just my speculation as a medical worker on the psychology of this kind of patients, but almost every day I can meet this kind of patients, I think this kind of speculation is not far from the truth. This kind of people are often discharged from the hospital are very unsatisfied, although the disease is cured, but fell on the hospital or unit of dissatisfaction. Needless to say, this person is usually in the unit is also full of complaints, depressed all day. 3, rights-based: always thinking about defending their rights, even more than the important premise of the cure. They moved the “Wang Hai fake” to the hospital. Doubt everything, do not trust the medical staff. Of course, the expansion of these people is due to the bad media. Imagine if you doubt everything about medical staff, what else can you trust? Compared with those government officials who are fighting for their jobs, medical personnel are considered pure, and I believe that most of them work on the basis of their skills. Recently, see the CCTV Eastern Time reported sky-high medical, on the one hand, to recognize the existence of hospitals indiscriminate charging phenomenon, on the other hand, we should also think about it, if the hospitals really in accordance with the state fees, hospitals can run down? Your country to the hospital how much funding? Recently, there is also the phenomenon of the Government reaching out to hospitals for money. Medical workers study more and work harder than any other profession, so why do they prefer to get less money than other professions? I, as a medical worker, absolutely no objection to the rights of the people, but please remember your original purpose of coming to the hospital! 4, negative style: loss of confidence in the performance of medical staff, loss of confidence in their own disease. This kind of person is actually in a position to treat the disease, but the treatment is not very positive. See a doctor not in time, take medication does not follow the doctor’s instructions, the medical staff is also not enough respect for their own lives do not attach importance to, and even the idea of lightness of life. I once met a patient, a distant relative of mine, with bilateral ureteral stones, anuria, and generalized swelling. I asked him to go to the hospital for treatment, but he said that he did not want to go to the hospital because a patient with the same symptoms as him had died in the hospital last time. Later, after repeated persuasion, he was cured after removing the stone. This kind of person has heard from hearsay that the same clinical manifestations are categorized as the same disease, and is negative about seeking medical treatment. Difficulty in seeking medical treatment in the tail section The tail section includes: agricultural laborers, unemployed and semi-unemployed people. This group of people have either just solved the problem of food and clothing, or they are hungry and full. They will not go to hospitals unless they have to. They generally do not have a strong sense of seeking medical treatment, nor do they have a high demand for services, and they think that seeking medical treatment is a difficult matter. There are four ways of seeking medical treatment: 1. Gambling: perhaps having a disease will lead to losing all one’s family’s money, and all one’s hope lies in this treatment, as seen in young agricultural laborers. Staying alive, even if there is no wood to burn! Therefore, they want the doctor to cure them with the best method, the best medicine, the fastest speed, and as for the cost, well, that’s how much it is anyway. This often makes the doctor very touched, but also very difficult. The reason is that sometimes it does not mean that with how much money to cure can be cured, may end up with people and money. Doctors know that this kind of patient will have a bad end, but it is impossible to explicitly say that they want to give up the treatment. Because the patient has been in a state of gambling, if you know all the family’s assets with its family can not cure the disease, the spirit will soon collapse. 2, quantitative: told the doctor that the economic situation is not good, to use the simplest treatment, the cheapest drugs, and even bargaining with the hospital. Most people think that only hospitals don’t haggle. In fact, I have encountered many bargaining patients during my time in the emergency department. They bargained differently from the regular shopping malls, always saying that it was too expensive and I was out of work, could it be cheaper. Or I don’t have that much money with me, can it be cheaper. In fact, the real need to rescue the emergency, we medical staff is no matter whether you have no money to rescue. 3, looking for fault type: focus is not in the treatment of disease, specifically looking for the hospital’s fault. Some people think this is a good way to make a living. I have to say, this is still attributed to those who eat nothing to do the work of journalists. Some jobless people have now made a career out of picking on hospitals. Of course, there are also those who specialize in picking on car owners. When I was on duty in the orthopedic department, I saw the same patient three times in a month. The history was simple, he was hit by a car, and the X-rays always showed a fracture of the toe phalanx, in the same place. Clearly a fraudulent driver. I had to expose his scheme, but he said, “Doctor, please don’t smash my job, or I will come to the hospital specifically to pick on him next time. So scary! 4, rogue style: no money anyway, relying on the hospital does not go out. This kind of people on the hospital does not mention excessive requirements, as long as not driven out on the line. Civil Affairs Bureau does not care, the Public Security Bureau does not care, they just find a reason to live in the hospital, as a nursing home. This is the most common in hospitals is the “three have-nots”. If there are so many “three have-nots” in such a developed place as Shenzhen, there should be quite a number of them on the Mainland, right? Who is managing these people? For these people, hospitals have become a vulnerable group because they cannot kick them out for fear of exposure! They cannot refuse treatment for fear of dying! Cannot tell the outside world – the national disgrace must not be publicized! There must also be medical staff to pay for boxed lunches – starvation is even worse! Third, from the behavior of seeking medical care to see the level of society In general, it seems that the behavior of seeking medical care, no matter which layer, can reflect the level of society. State and social managers use the “command style of seeking medical treatment” to indicate that they often use power when they should not, and should not act as an insider when they act as an insider, which reflects that the social management still exists in the phenomenon of bureaucracy. The “passive seeking of medical treatment” reflects the tendency of the medical staff to favor others. Managers and private entrepreneurs, this layer of the use of “money to the type of seeking medical care,” contributing to the emergence of social money worship, but also led to some doctors see money in the eyes of the open. Friendship-style seeking medical treatment reflects the social righteousness of the jianghu, and is suspected of using state resources to do private things. The professional and technical personnel, clerical staff, individual businessmen, commercial service employees, industrial workers, the five layers, is the main body of society. The emergence of pressure to seek medical treatment is natural, not medical itself caused, but mainly caused by social competition. How can there be no pressure when we all want to be close to the head and away from the tail? But the emergence of excessive medical care, rights-based medical care, negative medical care is often the result of social impatience. Than power, than money, and finally there is really nothing to compare than medical treatment, than the use of drugs. Therefore, health care reform should consult these people more, not just the state administrators behind closed doors, because the state administrators will not understand the pressure of seeking medical treatment. Agricultural laborers, the unemployed and the semi-unemployed are the lowest class in any era. Maybe we shouldn’t say that in today’s “equal for all” society, but it’s just the way it is. It is not the doctors who are to blame for their difficulties in seeking medical treatment; it is the result of insufficient medical resources in society. The State has invested too little in the medical industry, and such investment can only meet the basic medical needs of the head of the population, how can it take into account the tail of the population? Therefore, the gambling style of seeking medical treatment, the quantitative approach of seeking medical treatment, the fault-finding style of seeking medical treatment and the rogue style of seeking medical treatment are all understandable behaviors reflecting the existence of disparity between the rich and the poor in this society. The disparity between the rich and the poor exists in the entire human race, not just in China, so there is no need to worry. It is the disparity between the rich and the poor that motivates human progress, otherwise society would not develop. The relationship between medical behavior and social level is inextricably linked, and most of the phenomena in medical behavior can be attributed to the marketization of medical care, in addition to the feudal socialist ideology. The marketization of medical care cannot be successful at the current level of Chinese society. The marketization of medical care will inevitably lead to bureaucracy, money worship, tendency to be influenced by others, impatience, and disparity between the rich and the poor in the search for medical care. The marketization of health care can only be achieved when productivity is highly developed. And in today’s human civilization, science and technology is the first productive force. What does science and technology depend on? By education! Low social standards are actually a reflection of weak education. I think I have found the answer to this: education has been neglected in the reform or education has gone in the wrong direction. Isn’t it difficult to study now? The industrialization of education has deprived the poor of the opportunity to study, so that the rich do not have to study. If it is difficult for a society to get an education, what else is not difficult to do? Difficulty in receiving education inevitably leads to difficulty in studying medicine, and difficulty in studying medicine inevitably leads to difficulty in seeking medical treatment. When it is difficult to seek medical treatment, if we follow the present practice of grasping only the superficial phenomenon and finding fault with medical personnel, it will be even more difficult to seek medical treatment by then – because those who study medicine will resort to fleeing and will choose to give up. A simple reasoning is that if education is free, learning to be a doctor costs nothing. If it costs nothing to learn medicine, the number of medical personnel will inevitably increase, and there will even be a situation in which all the people are doctors, and then the problem of seeking medical treatment will no longer exist. Of course, this is only an ideal hypothesis, because under the present political system and economic conditions, it is impossible to make education free. I think that in order to solve the problem of health care reform, we should first solve the problem of education reform. And in order to solve the problem of education reform, the first thing that should be done is to reform the present political system, which requires real equality for all and real democracy. Only then will it be possible for everyone to enjoy the right to education, and only then will it be possible for everyone to enjoy the right to health care!