中国医生如何解决“回扣门”背后的危机

How to solve the crisis behind Bribegate for Chinese doctors

 

Recently, China’s Ministry of Health has continually declared that it will intensify its crackdown on bribery in hospitals, after news of a corruption scandal involving dozens of doctors in east China broke. An online post on Nov 15, 2010 alleged that dozens of doctors at several hospitals in Hangzhou, Zhejiang province, were taking bribes from a healthcare company. The doctors were said to have taken cash, motor oil, shopping cards, and digital cameras from a local medical device company, duly buying the company’s products in return. The blogger, under the name of CCTV9090, said that he had learned of this situation from a memory stick that he happened to find on a bus. Ten pictures were also published, in which the names of doctors and the kickbacks they allegedly took could be seen clearly. The public reacted angrily toward the doctors listed in the post, saying that they seriously undermined people’s confidence in and image of medical professionals, although insiders said it was an institutional problem. 



In our opinion, there are critical crises in China’s health system behind a situation commonly called Bribegate in this country. In China, it is common for pharmaceutical and medical equipment companies to pay kickbacks and bribes to doctors and hospital staff to boost product sales. It has become a hidden rule in the medical industry that doctors receive kickbacks which comprise part of the cost of drugs from pharmaceutical companies. Companies involved include bribe fees in their drug pricing. Medical equipment makers have also been involved in similar schemes. If a number of doctors in China prescribed drugs for patients depending on the amount of kickbacks from pharmaceutical companies, and not on the basis of treatment guidelines and the individual situation, it would be hard to say that Chinese patients have received the best therapy with most effectiveness and least cost. One patient in Beijing saw doctors in four different hospitals with the same medical complaint.7 He took back four kinds of prescriptions to an expert panel, who were masked to the names of hospitals and doctors, to make an evaluation. Astonishingly, in China’s capital city, only one prescription was appropriate for the patient—the other three doctors had prescribed superfluous or improper drugs. It is unknown whether this problem is prevalent throughout the country.

 

Chinese doctors’ salaries are indeed small when compared with the high incomes that are paid in some monopoly industries in China with lesser technical skills than medicine, such as banking and transportation. Many physicians and surgeons consider kickbacks and bribes from drug companies as compensation for their high training costs and high professional risks. Doctors who are busy prescribing medicine to get kickbacks would effectively become the “employees” of downstream companies in the medical industry. Such doctors do not devote themselves to the advancement of medical knowledge or techniques, or to the improvement of health-service quality. This issue is one reason why there is little or no clinical evidence from China in many international guidelines. Few voices are heard from Chinese doctors in various world congresses when treatment guidelines are drawn up. We assume that this awkward situation will continue for a long time.

 

Bribegate is just the tip of an iceberg, although the government will take steps to improve the situation by stricter regulation and punishment, including suspension or revocation of medical licences in serious cases.  Bribery in hospitals has increased in some areas of China, according to a news report about the Ministry of Health. We are much more concerned over the quality of the health care that patients have received and the improvement of clinical practice behind Bribegate in China. Chinese medical associations should develop rational drug-use guidelines to standardise doctors’ prescribing behaviour. Although there have been many guidelines for different diseases in China, which were released by both local and national associations, the implementation of existing guidelines among Chinese doctors is severely lacking. Thus a few doctors are improperly motivated to prescribe for financial gain. Significantly, China’s Cabinet has initiated salary reform in medical institutions in a bid to curb the bribery of medical workers and reduce costs for patients. We have reason to look forward to a healthy medical system in China that satisfies both patients and doctors.

 

Zhiping Yang, *Daiming Fan

Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, China [e-mail]  

（ZT  柳叶刀杂志 January 21, 2012）