The Cadrefication of Medicine: Administrative Absorption and Professional Alienation in China’s Grassroots Healthcare

China’s county-level healthcare system is increasingly governed by administrative performance indicators, transforming clinical practice into bureaucratic compliance. Based on in-depth interviews with 12 frontline doctors in Henan Province and an analysis of policy texts from 1986–2026, this paper proposes the concept of “cadre-ized healthcare.” It argues that Chinese physicians have been institutionally embedded as “technical cadres” within a dual evaluation system prioritizing political quality over professional competence. Facing intense administrative pressure amid resource scarcity and demographic aging, doctors have developed systematic “self-protection” strategies—including defensive medicine, medical record embellishment, systemic rule evasion, and professional exit. These behaviors mirror the “self-informing” tactics observed among grassroots cadres. Integrating theories of professional autonomy, street-level bureaucracy, and the Red Queen effect, the study demonstrates how performance governance converts professional actors into administrative assessment targets. Furthermore, it reveals that AI-driven regulatory countermeasures have not resolved these dilemmas but instead triggered a dynamic arms race between regulators and practitioners. This research contributes to medical sociology, cadre system studies, and public management theory by offering a new analytical lens for understanding governance crises in China’s professional service sectors under the cadre state logic.