From regulation to real legal cases: physician-patient disputes as a lens on universal health coverage governance in China, 2015-2025.

Physician-patient disputes (PPD) have been increasingly recognized as structural indicators of health system performance, yet they remain underexplored within universal health coverage (UHC) frameworks, particularly in the Chinese context. This study employed a mixed-methods approach integrating regulatory review and legal cases analysis, revealing that the regulatory framework for PPD has evolved from fragmented arrangements toward a more integrated civil, criminal, and administrative system, encompassing three stages: ex ante prevention, in-process management, and ex post dispute resolution and sanctioning. We analyzed 4,243 physician-patient disputes cases (2015-2025), comprising 4,086 civil, 56 criminal, and 101 administrative cases. A marked decline was identified in publicly available dispute cases after 2019. This decline was temporally associated with major regulatory reforms and the COVID-19 pandemic, although the descriptive design of this study does not establish strong causation. The underlying structural drivers remain unresolved: 51.3% of civil cases arose from patients' subjective perception of care failure rather than confirmed clinical fault, may point to a systemic deficit in physician-patient communication. Criminal cases were disproportionately associated with critical illness and high financial burden, suggesting that incomplete financial protection may contribute to extreme forms of physician-patient conflict. Over 91.7% of all disputes were concentrated in tertiary hospitals, reflecting potential structural imbalances in resource distribution. This study suggests that PPD may be a form of institutional risk transfer originating from systemic deficiencies within the UHC framework. Legal governance alone may not be sufficient to achieve UHC goals; effective system performance ultimately depends on trust, equity, and accessibility within the health system. Future policy may consider strengthening security measures in high-risk departments, improving financial protection for high-cost conditions, developing communication-support roles, strengthening family doctor services at lower-level institutions, and testing patient engagement mechanisms to support shared decision-making.