Perceptions of Chinese medical workers have changed dramatically. Just three years ago, they were hailed as ‘white angels’ and ‘heroes who take risks’. Today they find themselves embroiled in an unprecedented anti-corruption campaign. to promotesystematic governanceThe campaign seeks to uncover questionable relationships between hospital administrators, doctors and medical representatives across the healthcare sector. As of July 31st, an investigation into the overage was initiated. 155 Hospital Director, more than double the previous year’s total. Hospital director and party secretary to be dismissed in August almost every day. Repression took place on August 7 alone wiped out A-share healthcare stocks, once considered safe havens, have a staggering 200 billion yuan ($27.9 billion) market capitalization.
While the Chinese media is replete with discussions about the campaign, discussion of why the government is now increasing its focus on corruption in the health sector is conspicuously absent. Medical corruption has long been a top complaint in China. This is particularly interesting given the history of publicized hospital corruption cases.Corruption incidents in public hospitals, according to a study published in the Chinese Journal of Medical Management peaked in 2017 Bribery remains the main form of corruption in the healthcare sector.However, traditional practices such as receiving “red envelopes” from patients are largely replaced by commercial bribery, the process by which drug and medical device suppliers offer bribes to government officials and health care providers to ensure their competitiveness. Nevertheless, due to medical reforms and regulations such as the abolition of drug markups and group procurement by medical insurance, limited the scope of such commercial bribery;
This raises the question of what is the underlying motivation for the campaign.in John Kingdon’s Public Policy ModelEven when policy issues are recognized and intervention is required, the convergence of issues, policy solutions and political ‘currents’ opens a window for change. The timing of the anti-corruption campaign coincides with the slowdown in economic recovery after COVID-19, highlighting the urgent need to stimulate domestic consumption.As Tsai FangA prominent Chinese economist said, “The most pressing goal now is to stimulate private consumption.” But concerns about long-term spending on health care, housing, and education are holding back spending growth. The introduction of universal health insurance over the past decade has not significantly reduced the financial burden of health care for many Chinese. The economic downturn after COVID-19 has given people even longer time to make consumption decisions.
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A more realistic solution would be to provide free health care, or at least significantly reduce out-of-pocket medical costs. Li Lin, a health economist at Peking University, said: pointed out Last year, China’s medical spending reached 7 trillion yuan ($975 billion). This amount, in theory, should be sufficient to ensure free and quality health care. However, over the past three years, the large amount of money that has been channeled into zero-corona implementation, combined with declining fiscal revenues in economic centers, has strained the country’s ability to fund health care and other priority policies. It’s hanging In cities such as Wuhan and Dalian, cash-strapped local governments have opted to cut investments in healthcare.decision sparked protests is similar to anti lockdown demonstration This raises questions about the legitimacy of the government and threatens its stability.
Of course, ordinary Chinese welcome this move by the government. By shifting the focus of its fight against populist corruption to the health sector, the government is tactically shifting the blame onto hospital managers, doctors and medical personnel. This biased strategy protects the government from becoming a prime target for public grievances that can undermine its authority and legitimacy. Moreover, recovering illicitly obtained funds could help close the fiscal gap. Analysis of 3,546 corruption cases from 2013 to 2019 found The average bribe was 783,000 yuan ($110,000), but there were 468 cases where staff and hospital directors received more than 10 million yuan ($1.4 million), with the highest bribe of 100 million yuan ($14 million). was beyondThe cumulative amount of corruption is believed it It is expected to exceed 2 trillion yuan ($278.6 billion).
No wonder local governments are also cooperating with the campaign. More than 10 states to officially open by August 14 started A year-long crackdown on medical corruption. Healthcare workers are now expected to: Repay Unfair compensation received from 2018 to May 2023 (including fees from speaking engagements, training, seminars, and related activities). The Beijing Municipal Health Commission recently introduced A “good faith account” that allows doctors to return bribes and be forgiven for past mistakes. As a proactive measure, the Shanghai Municipal Government offered a large rewardThose caught illegally trading or violating regulations face fines of up to 1 million yuan ($139,000).
The campaign has the potential to significantly advance China’s healthcare reform. Breaking the cycle of corruption and banishing unscrupulous providers not only makes health care more affordable, but also paves the way for a future rethink of how health insurance is paid and how doctors are paid. But the campaign doesn’t address the main culprit: public hospitals, which provide about 90 percent of the country’s inpatient and outpatient services. Labeling them “public” is misleading, as only about 10% of their income comes from government funding. They primarily function as profit-seeking machines. And the crackdown is far from complete. It remains to be seen whether attention will shift from the “usual suspects” such as hospital administrators to health officials who are in trouble. final decision For procurement of expensive and bulk equipment and medicines.according to the study Under the auspices of the National Health Commission, 45 percent of bribery cases occur at the decision-making stage, with almost half of those involved in bribery in administrative positions, with senior leaders accounting for 30 percent. During the COVID-19 epidemic, decisions regarding the procurement of nucleic acid reagents and vaccines hotbed of corruptionprovoked public outrage.
A zealous anti-corruption campaign can have disastrous and unforeseen consequences. One obvious result is the defamation of doctors. Sun Ningling, a prominent doctor at the People’s Hospital of Peking University, said: lamented: “Recently, both mainstream and independent media have been keenly spotlighting anti-corruption in the healthcare sector … All necessary prescriptions and the use of imported medical devices for testing and treatment are simply treated as nonsense. , as if all physicians have abandoned medical ethics: a kickback plan.” Slandering physicians does not encourage an exodus of physicians and undermine the health care system’s ability to meet surging healthcare demands. There is growing concern that Those who stay may embrace a passive “lying down” mentality.some reports suggest Doctors are currently reluctant to attend conferences or prescribe imported drugs.Leading Hospital in Southern Province observed Declining markets for orthopedic and eye surgery have led to a consistent avoidance of previously optional surgeries. This can jeopardize patient care and hinder access to vital medicines and essential health services, further straining patient-physician relationships and exacerbating health problems. Hospital violence against doctors. in the darkest prospects, warned “This could lead to the complete dismantling of our country’s medical infrastructure,” said the director of a major hospital.
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The hospital director’s warning text highlights the far-reaching impact of using campaigns as a policy tool in China. In recent years, the government has rolled out several high-profile campaigns that promise to ease the burden on the “triple mountain” of housing, education and health care. But attempts to curb debt and property speculation have resulted in a real estate slump, forcing the government to reverse policy amid the post-COVID-19 economic downturn. A widespread crackdown on for-profit after-school tutoring has led to the closure of many businesses without effectively addressing the social inequalities they promised to remedy. Instead of drawing lessons from these campaigns, the government is now launching another campaign centered around the ‘third mountain’, health care. It is unlikely to yield better results than previous efforts.
