Monday, 25 November 2013

Medical corruption is an institutional problem for China

An article by Dr Zhang Yi of the Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University in the European Journal of Internal Medicine.

"In the last ten years, medical corruption has become one of the top complaints from the Chinese public. It is an open secret in China that some pharmaceutical companies pay kickbacks to doctors and hospital administrators to boost drug prescriptions. This problem is prevalent in the country and has run rampant in some areas, seriously undermining patients' interests and doctors' professional images.

In early July, the British pharmaceutical giant GlaxoSmithKline (GSK)'s bribery scandal shocked China and sparked widening concern as well as dispute over the country's pharmaceutical sector. It is believed that China's drug market is extremely chaotic with thousands of pharmaceutical companies in existence and the intense competition results in an unhealthy environment. Some companies engage in bribery to raise drug prices, expand sales and reap inappropriate profits. The various forms of malpractices between drug companies and doctors include cash kickbacks, lavish gifts or entertainment, all-expenses-paid trips, ghostwriting services, sponsored supplements in journals and even sexual favors.

Recently, the city of Zhangzhou in southeastern Fujian Province has been hit by a corruption scandal involving all the city's hospitals. It is reported that 1088 doctors and 133 administrators from 73 hospitals of the city were found taking bribes and kickbacks, totaling US$ 3.34 million. Moreover, in Pinghe County of the city, nine out of ten doctors were suspected of taking kickbacks from drug makers or distributors. The Zhangzhou case is just the tip of an iceberg but exposed again the severity of corruption in China's healthcare industry.

Since 2009, China has launched an ambitious health care reform. It has committed itself to providing adequate and affordable health care services for its 1.37 billion people. However, exorbitant drug prices have been the center of complaints about China's healthcare system for years. It is reported that a single injection of clindamycin phosphate is sold to patients for RMB 11.5, which is ten times more than its actual cost. More than half of such margins are used to bribe doctors and officials. It is a “hidden rule” in China's medical sector that doctors take bribes and kickbacks which comprise part of the costs of drugs. Although the public are very dissatisfied with the status quo, insiders hold that it is an institutional problem.

In China, it is common for public hospitals to use drug sales to compensate for insufficient government funding, which provides chances for some doctors to supplement their meager incomes with kickbacks from drug companies. It is believed that corruption in China's healthcare industry is fueled partly by the low base salaries of doctors at the country's approximately 13,500 public hospitals, which on average are only 1.19 times higher than those of the rest of the population. A number of physicians and surgeons regard taking bribes and kickbacks from pharmaceutical companies as compensation for their high training costs and high professional risks. However, if doctors in China prescribed drugs for patients depending solely on economic interests, but not on evidence-based clinical practice guidelines, it would be hard to say that patients in China receive the most cost-effective treatments. It is a sad fact that in the eyes of many Chinese people, the term “doctor” is likely to be connected with “prescription abuse”, “excessive examination” or “gray incomes”. The unethical relation between pharmaceutical companies and doctors inevitably damages the doctor–patient relationship and ultimately the whole healthcare system of China.

Therefore, it is imperative for China to step up crackdown on medical corruption. The recent investigations into malpractices between pharmaceutical companies and doctors have shown China's resolve to crack down on corruption in healthcare industry. However, the anti-corruption efforts would not solve the thorny issues if China's health care reform did not go far enough. A comprehensive reform focused on changing the unsound healthcare system is urgently needed. Although we do not agree with some doctors who think it is acceptable to take bribes and kickbacks from drug companies due to low salaries, there should be an appropriate income system to bridge the gap. We deem that medical corruption in China could further be better tackled through decent wages for medical staff, strict conflict of interest rules, effective surveillance systems and severe punitive measures."

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