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http://www.lancet.com/journals/lancet/article/PIIS0140-6736(11)60137-2/fulltext
The Lancet, Early Online Publication, 21 March 2011
doi:10.1016/S0140-6736(11)60137-2 Cite or Link Using DOI
柳叶刀 在线发表 2011年3月21日
How to solve the crisis behind Bribe gate for Chinese doctors
如何解决中国医生的商业贿赂问题
Original TextZhiping Yang a, Daiming Fan a
Recently, China's Ministry of Health has continually declared 1 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 2 on Nov 15, 2010 alleged that dozens of doctors at several hospitals in Hangzhou, Zhejiang province, were taking bribes from a health-care 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 ?nd on a bus. Ten pictures were also published, in which the names of doctors and the kickbacks they allegedly took could be seen clearly.3 The public reacted angrily toward the doctors listed in the post, saying that they seriously undermined people’s con?dence in and image of medical professionals, although insiders said it was an institutional problem.
近来，中国卫生部一再宣称将强化对发生在医院的贿赂的惩罚,中国东部地区许多名医生涉及贿赂丑闻的新闻曝光后。2010年10月15日，有人发帖，浙江省杭州市几家医院的许多名医生受贿于一家卫生保健公司的贿赂。医生们被接受了一家当地医疗器械公司的现金、车用汽油、购物卡和数码相机，及时使用公司的产品作为回报。一个叫CCTV9090博主说，偶然他是在一辆公交车上捡到了一个U盘知道了所述情况。医生的名字和收受的回扣及照片被清晰的公示在上面。虽然行内人士说这是体制问题，网名们对帖子中的医生的行为感到生气，认为他们严重伤害了网民的信任和医疗行业的形象，。
In our opinion, there are critical crises in China’s health system behind a situation commonly called Bribe gate in this country. In China, it is common for pharmaceutical and medical equipment companies to pay kickbacks and bribes to doctors and hospital sta? to boost product sales.4 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.5 Medical equipment makers have also been involved in similar schemes.6 If a number of doctors in China prescribed drugs for patients depending on the amount of kickbacks from pharmaceutical companies, and not of treatment guidelines and the individual situation, it would be hard to say that Chinese patients have received the best therapy with most e?ectiveness and least cost. One patient in Beijing saw doctors in four di? erent 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 super? uous 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.8,9 Many physicians and surgeons consider kickbacks and bribes from drug companies as compensation for their high training costs and high professional risks.10 Doctors who are busy prescribing medicine to get kickbacks would e?ectively 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,11 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.1,3 Bribery in hospitals has increased in some areas of China, according to a news report about the Ministry of Health.12 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’
贿赂们只是冰山一角，尽管政府将通过更加严格的管理和处罚来改善这种现状，包括在严重的情况下暂停或吊销医疗执业证书。根据关于卫生部的一条新闻报告，在中国的一些地区，医院贿赂的情况在逐渐增多。在中国贿赂门发生后，在医疗技术的进步的条件下，我们更加关注的是患者得到的医疗服务的质量。中国医学协会应该制定合理用药管理指南来规范医生的行为。
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