Underpaid doctors trapped in chain of medical corruption(2)

Interest chain

According to Cai Xiangdong, director of the CDI at Zhangzhou Health Bureau, the whole corruption scandal this time was initially started from external reports. When the hospital management followed the clues and caught some medical representatives in the act, they confessed that all hospitals in the city were involved in their bribery scheme.

Under the current medical system in China, there are at least four steps that any new drugs must go through before making it into patients' hands. But each of these carries ample opportunity for illicit profit.

First of all, all medicine allowed to be sold in each province must enter the provincial drug procurement directory before being up for approval at the city or county level. After that, hospitals can then choose drugs from that narrowed list and finally, doctors can hand out prescriptions with the final word on which medicine gets used or not.

As a result, pharmaceutical companies have to spend a lot of money each step of the way to ensure their products can smoothly access the marketplace, despite fierce competition.

According to confessions from pharmaceutical representatives, more than half the costs for medicine is actually spent on "public relations." Among them, 15 percent goes to government organs in charge of the drug procurement directory, 25 percent to take care of hospitals and doctors and only 10 percent goes into the representatives' own pockets.

For example, an Oxiracetam injection priced at 56.8 yuan could net up to a 20 percent kickback for doctors. This medicine totally sold out in 2011 and 2012 in Zhangzhou, and the doctors who used this medicine made 156,000 yuan in kickbacks from medical representatives because of this one drug alone. For doctors whose salaries are only a few thousand yuan a month, the temptation of such profits was often too hard to resist.

Although the Zhangzhou CDI refused to reveal the names of the companies involved in the case to the Global Times, many among the public believe that only the tip of medical corruption has been revealed so far.

Cai told the Global Times that they had taken measures including random checks on the top 10 doctors in each hospital, to look for the usage of drugs, the doses prescribed and the prices charged. This verified if the doctors' prescriptions were reasonable.

But Cai explained the prices for all medicines were set by the provincial level government, and they could do nothing about the price.

According to Professor Li Ling from the National School of Development at Peking University, and a member of State Council Medical Reform Advice Committee, the current price-setting system has to improve.

"The price set by authorities in the drug procurement directory comes from the cost that medicine producer reported plus 15 percent reasonable profit space. But many medicine producers play tricks. On the one hand, they add a lot of hidden 'public relations' fees to the cost, on the other hand, nobody could be knowledgeable enough to know every sort of medical cost," Li said.

But a senior executive of a major hospital in Zhangzhou who asked not to be named told the Global Times he thought corruption was a deep-seated social problem rather than a medical issue alone.

"The income of doctors doesn't match their contributions to society and it is therefore hard to eliminate corruption," he said.

According to him, hospitals and doctors are also the victims of the current system which lacks a good top-level design.

Need for reform

Li Ling believes a comprehensive reform focused on changing the unreasonable treatment system of medical staff is urgently needed.

"Doctors should feel respected in terms of their income and treatment. Judging the performance of a doctor should not depend on how much medicine they have sold and their salary should be absolutely separated from medical fees," Li told the Global Times.

According to Li, China's health authorities have long been aware of the problem plaguing the medical profession, but the latest reforms were back in 2009. However since then, all government efforts have stopped and the situation is worse than before.

Yu Mingde, director of the Chinese Pharmaceutical Enterprises Association, told CCTV that he thought that building a healthy marketing system might be helpful to eliminate medical corruption at the root level.

"Market-oriented medical services are a trend, instead of everything remaining forever monopolized by the government. After all, the government can't take care of everything no matter how much they invest. Only when hospitals are given enough autonomy to shift their focus to provide the best care at the best price, will we be able to unmake the bed of corruption," Yu said.