Analysis of the hurdles to cross for public hospitals in China in their reforms, and appraisal of the achievements and setbacks found in the healthcare system reform in the past 30 years. These form the basis for the recommendations for pragmatic reform measures in public hospitals, for improvement of the medical charge pricing system and clarification of the coverage of the essential medical services; for establishment of medical groups or medical consortiums and regulation of patients treatment seeking behavior; and for finalizing the corporate governance structure of public hospitals.

Objective To find out the tendency of medical accident arbitration in 5 hospitals of Shanghai and the causes. Methods Cases involving medical accident arbitration that occurred in the 15 years running from 1985 to 1999 in 5 third tier hospitals of Shanghai were collected and a retrospective correlation analysis was conducted. Then 45 of the cases were selected by random sampling and a detailed analysis was made. Results ①During the 15 years the number of cases involving medical accident arbitration by class 1 commissions was 295, with the average number per year in the latter five years rising 51% as compared with the first ten years. ②There was no significant correlation between the number of cases involving arbitration and the number of cases judged to be accidents. ③There was no correlation, either, between the total volume of emergency outpatient service, which amounted to 68, 6 million visits, and the number of cases involving medical accident arbitration. ④The sample survey showed that the operating room and the emergency room were sections where medical accidents occurred most frequently. Conclusion In the past 15 years, the number of cases involving medical accident arbitration has been on the rise, yet there is no correlation between the rise and the number of cases judged to be accidents or the volume of medical service. The causes for the rise include both iatrogenic and non iatrogenic ones. The paper puts forward 6 countermeasures.