On the Labor Protection ofChinese Healthcare Workers: —A Legal Analysis of the Public Institution Personnel Employment Relationship

Public hospital medical personnel, as the core workforce of the public health system, have long found the protection of their labor rights trapped in a doctrinal dichotomy between “personnel appointment relationships” and “labor relationships.” Under the administrative logic of bianzhi (establishment-based) status, staff within the establishment are excluded from the core baseline protections of the Labor Law, such as limits on working hours and overtime compensation, which has given rise to systemic deprivation of rights in the form of “institutionalized overwork,” a divergence between pay-setting and the actual value of labor, and the absence of effective remedies for occupational safety. This protection blind spot stems from a normative gap at the legislative level, the lingering judicial subconscious of the “special power relationship” theory, and personnel management strategies in public hospitals that, under conditions of “soft budget constraints,” internalize operating costs. In response to these problems, a doctrinal reconstruction path is proposed through the construction of a “special labor relationship”: establishing a rule on the application of law that takes protection under the Labor Law as the general principle and administrative management as a narrowly defined exception; relying on medical service pricing reform to restore the value of technical and service labor; and, by activating the procedural rights of employees representative congresses and building a dual-track accountability mechanism operating in parallel under public and private law, promoting a transition from administrative dependence to rights protection grounded in the rule of law, so as to resolve the conflict between the “status” and the “contract” of medical personnel.