On February 17, the official website of the Discipline Inspection Commission of Deyang City, Sichuan Province announced that Li Rui, secretary of the Party Committee of Mianzhu Traditional Chinese Medicine Hospital, was investigated. According to his resume, Li Rui is 55 years old and has been the director of the hospital for 11 years. On the same day, the official website also said that Zhang Dejun, deputy secretary of the party committee and president of the Second People's Hospital of Deyang, was investigated.
In recent years, news of hospital leaders being investigated has been common. For example, Wang Tianchao, former president of the First People's Hospital of Yunnan Province, who accepted 100 buildings and 100 parking spaces and received a total bribe of more than 110 million yuan; Liao Min, former president of the Third Clinical Medical College (Third Affiliated Hospital) of Gannan Medical College in Jiangxi Province, colluded with medical businessmen, in a vain attempt to evade investigation through "political swindlers" to dredge up connections.
A number of cases show that the problem of corruption in the medical system is mainly concentrated in drug distribution, equipment procurement, consumables supply, engineering construction, etc., and the extra costs paid by hospitals will be passed on to patients and finances.
Zhao Chun, chairman of the Medical Clinical Specialty Development Committee of the China Medical Foundation and vice chairman of the Medical and Health Institution Supervision Committee of the China Health Supervision Association, worked in the hospital evaluation committee of the former Ministry of Health in the 90s of last century. In an interview with China Newsweek, he said that medical corruption has a long history, and some regulations have been issued in various places, and certain results have been achieved, but so far they have been repeatedly prohibited, and corruption has become more and more hidden, and it is difficult to investigate and deal with it.
Why is corruption in the healthcare system so persistent?
Photo/Visual China
Deans have become a group with a high incidence of corruption
According to incomplete statistics from China Newsweek, in 39 days from January 9 to February 17 this year, at least 26 hospital leaders were dismissed, expelled from the party, or arrested. Of these, 19 have served as deans and 7 as vice-deans.
Among the above 26 people, 18 people were investigated, including Ma Runzhou, former president of Leling People's Hospital in Shandong Province, and Xiao Junbing, vice president of the First People's Hospital of Guiyang County, Hunan Province; Five people were double-opened, including Hou Yuezhi, former secretary of the Party Committee and former president of the Second People's Hospital of Binzhou City, Shandong Province, Qing Song, former vice president of Ziyang People's Hospital of Sichuan Province, Liao Min, former president of the Third Clinical Medical College (Third Affiliated Hospital) of Gannan Medical College of Jiangxi Province, Wu Guangming, former president of Dafang County People's Hospital of Guizhou Province, and Chen Wenkai, former president of Pengpai Memorial Hospital in Haifeng County, Shanwei City, Guangdong Province; Two people were arrested, namely Feng Yong, former president of Yinjiang Autonomous County People's Hospital in Guizhou Province, and Yang Yulin, former president of Xingyi People's Hospital in Guizhou Province; One person was expelled from the party, his retirement benefits were revoked, and the suspected crime was transferred to the procuratorate for examination and prosecution according to law, namely Zhao Wensheng, former secretary of the party committee and former president of Dehong Prefecture People's Hospital.
Judging from the relevant reports, they mostly involve the collusion of medical businessmen. For example, Hou Yuezhi, who "intervened in the bidding activities of engineering construction and medical equipment procurement projects", and Qing Song, who "sought benefits and received money and goods in drug procurement and fund allocation, and received a particularly large amount of money".
In recent years, the leaders represented by the president of the hospital have become a group with a high incidence of corruption. According to incomplete statistics from the People's Daily health client, in the first 11 months of 2022, a total of 55 hospital presidents and secretaries were investigated. Including Wei Yongxiang, former president of Beijing Anzhen Hospital affiliated to Capital Medical University, Wang Binquan, former president of the First Hospital of Shanxi Medical University, and others.
In 2022, the anti-corruption film "Zero Tolerance" mentioned the corruption of the medical system represented by the dean. According to the film, Ma Linkun, former president of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province, received more than 30 businessmen's property, equivalent to more than 30 million yuan. In the process of purchasing large-scale medical equipment at the hospital, Ma received huge amounts of money from distributors.
"A typical piece of equipment is a digital angiography system, and the price that the agent gets from the manufacturer is 5.79 million yuan, and the contract price sold to the hospital is 11.7 million yuan, which is equivalent to doubling." Yang Xinyu, a staff member of the Yunnan Provincial Commission for Discipline Inspection and Supervision, said.
In July 2021, Malinquin was placed on file for review and investigation. The circular said that it enjoyed the extreme flattery and flattery of illegal drug manufacturers, and used its authority to use the qualifications for the procurement of medical equipment, drugs and consumables as a bargaining chip, and formed an alliance of interests with illegal drug manufacturers for a long time.
On July 13, 2018, Wang Tianchao, former president of the First People's Hospital of Yunnan Province, was sentenced to life imprisonment for accepting bribes. After the trial, it was found that he provided assistance in hospital engineering construction, procurement of drugs and medical equipment, appointment and dismissal of personnel, etc., and accepted bribes from companies and individuals totaling more than 116 million yuan and 80,000 US dollars.
Wang Tianchao said that he had accepted bribes from the owner of a real estate enterprise to bribe 100 houses and 100 parking spaces, worth more than 80 million. He also violated discipline and law by accepting bribes of more than 200,000 yuan from hospital staff and accepting gifts and 1.5 million yuan in gift money on many occasions.
Wang Xiuhua, former secretary general of the Shandong Hospital Association, wrote an article entitled "How to learn from the "Wang Tianchao phenomenon"? It is said that the president of the hospital is the only "long", not only is it difficult to implement the collective decision-making mechanism of the leadership group in the hospital, but even the supervision of the party committee and discipline inspection commission has been seriously weakened, and some are even useless.
On June 22, 2020, the Yunnan Provincial Commission for Discipline Inspection and Supervision released a video educational film "Qingfeng Yunnan" that Yang Benlei, former secretary of the Party Committee and former president of Chuxiong Prefecture Traditional Chinese Medicine Hospital, hid a huge amount of bribes in several large wine tanks on the outskirts of the city, and the money was moldy and emitted an unpleasant smell after opening. The case-handling personnel said that Yang Benlei has the final decision in drug procurement and equipment procurement, and it is up to him to give a little more share and which one to hand over the equipment to.
A doctor from a third-class hospital in Shandong Province told China Newsweek that the medical system has a high threshold and is highly professional, and the president is usually an administrative leader and an authoritative expert in the industry, with a lot of say. In the absence of oversight, corruption is prone to occur.
Zhao Chun said that although some public hospitals have medical device committees and pharmaceutical affairs committees, the secretary or president has an important say in the promotion of others, so when they insist on purchasing a certain device, few people will raise objections.
Wang Xiuhua said that in the short term, it is necessary to list the powers of hospital presidents, make real administrative affairs public, and strengthen the supervision of relevant channels such as staff congresses, so as to reduce or even cancel the space for black-box operations.
Corrupt tactics are becoming increasingly hidden
Multiple cases of medical corruption involving kickbacks show that this chain of corruption involves pharmaceutical companies, medical representatives, hospital leaders, etc.
In March 2022, in a case published on the website of the State Supervision Commission of the Central Commission for Discipline Inspection, Tang, a medical representative of a pharmaceutical company in Jia County, bribed the vice president of the hospital, prescription doctors, and pharmacy staff after discussing with the pharmaceutical company to sell drugs that were on the verge of expiration. TANG GOES TO HU, CHEN AND WANG IN THE PHARMACY OF COUNTY CENTRAL HOSPITAL EVERY MONTH, COLLECTS THE AMOUNT OF PRESCRIPTIONS OF DRUGS PRESCRIBED BY EACH DOCTOR, SUMMARIZES THEM AND ENTERS THEM INTO AN EXCEL TABLE, CALCULATES THE REBATE TO THE RELEVANT VICE PRESIDENT, THE CLINICAL FEE TO THE PRESCRIBING DOCTOR, AND THE GENERAL FEE TO HU, CHEN, WANG AND OTHER PERSONNEL, AND THEN GOES TO THE PHARMACEUTICAL COMPANY TO REPORT THE ACCOUNT. After reporting the bill, he sent the envelope containing the money to the relevant vice president, doctors and pharmacy staff.
On February 6, the website of the Central Commission for Discipline Inspection and the State Supervision Commission published an article entitled "Strict Investigation into the Transmission of Hidden Benefits in the Medical Field," mentioning the details of He Xianwei's medical corruption case. He was the president of the Huzhong District People's Hospital in Daxing'anling Prefecture, Heilongjiang Province, and he wore ordinary clothes, drove second-hand cars, and lived frugally, but he accepted drug kickbacks. In June 2014, He, who had been the president for more than half a year, took the initiative to contact He Moumou, chairman of a pharmaceutical company, and the two sides agreed to meet in a secluded alley. He threatened to "not give kickbacks and no medicine", and finally agreed to give He a rebate of 15% of the total amount of drugs purchased by Huzhong Hospital in the company from August of that year. He also put forward two conditions: it must be cash, it must be confidential, otherwise there will be no more cooperation.
According to the special case team, the case involved more than ten pharmaceutical and medical device companies. Due to the strong concealment of criminal acts, it has increased the difficulty of investigation and punishment. In July 2021, when the local Commission for Discipline Inspection and Supervision was investigating another case, a briber voluntarily confessed to Xiang He's bribery, and He's bribery network was broken.
Other covert forms of bribery are mentioned above. Huang Xianfang, member of the Standing Committee of the Yuhuan Municipal Party Committee, secretary of the Municipal Commission for Discipline Inspection and director of the Supervision Commission, introduced that there are four types of hidden methods, such as "customized" bidding, which refers to the use of strong medical professional barriers to increase the "customized" bidding and screening rules in the bidding of medical supplies and medical instruments, so as to achieve the purpose of long-term cooperation and two-way benefit with "designated" pharmaceutical companies in disguise; Another example is "evasive" entrusted procurement, which refers to the private operation of the procurement "public power" into a third-party procurement agency company through private "aggregate" and behind-the-scenes manipulation, which can not only avoid the risk of violation of rules and disciplines in management, but also use the entrusted agency fee, item price difference, capital turnover rate, etc. to make a fuss; There is also a "rights issue" dividend, which refers to the use of hidden "rights" shares, disguised subsidies for seminars and training, and free or low-cost cash of gift drugs, etc., to promote the two parties to negotiate and reach a "high-price agreement" on pharmaceutical sales, forming a chain of pharmaceutical rebate interests; There is also a "welfare-style" seminar and training, which refers to the "inclusive", "recuperation" and "emotional connection" benefits that pharmaceutical companies give back to the managers and medical employees of medical institutions in disguised ways to maintain the alliance of interests.
Zhao Chun told China Newsweek that some pharmaceutical companies have been working in the medical industry for many years and are well versed in bribery. In the past, many hospitals had signs with the slogan "No drug merchants from entering", but with the upgrading of scientific and technological means and flexible and diverse contact methods, they can contact hospital leaders without going to the hospital. The way bribes are paid has also become bizarre.
"For example, a lot of people are around 50 when they become deans, which means that they retire after another 10 years or so. When a pharmaceutical merchant wants to corrupt the dean, he does not pay bribes in office, and waits until he retires. This kind of 'option-type corruption' has also made it difficult to investigate and deal with it. Others bribe close relatives of hospital leaders without leaving a trace. He said.
Zhao Chun said that at present, the market competition for medical equipment in mainland China is very fierce, and there are many repetitive productions. For example, there are dozens of domestic color ultrasound manufacturers, the quality is similar, some manufacturers will rely on bribery and other means to open the market, "even a blood pressure monitor, a few dollars a pack of medical gauze blocks and other consumables into the hospital, and reach a certain amount, will provide operating space for the camera obscura." ”
The problem of corruption in the medical system mainly focuses on drug distribution, equipment procurement, consumables supply, and engineering construction. Photo/Visual China
How to solve the problem of medical corruption?
Since the reform and opening up, the management system of mainland public hospitals has gone through three stages. In January 1982, the former Ministry of Health issued the Regulations on the Work of National Hospitals, clarifying that hospitals implement the president responsibility system under the leadership of the Party Committee. This is considered by the industry to be an important attempt to change the phenomenon of indifference between party and government in medical institutions.
In March 2000, the Organization Department of the CPC Central Committee, the former Ministry of Personnel and the former Ministry of Health issued the Implementation Opinions on Deepening the Reform of the Personnel System of Health Institutions, proposing that "health institutions should implement and improve the responsibility system for hospital (institute and station) directors" and "establish and improve the responsibility system for term goals, and clarify the responsibilities, rights and interests of hospital (institute and station) directors". Since then, the director has been in a dominant position in the hospital.
Until June 2018, the General Office of the Central Committee of the Communist Party of China issued the "Opinions on Strengthening the Party Building of Public Hospitals", which clearly proposed that public hospitals implement the president responsibility system under the leadership of the Party Committee.
Emphasizing that public hospitals implement the system of responsibility of presidents under the leadership of party committees, Zhao Chun said that one of the main reasons may be that many presidents have experienced corruption problems in recent years and need to restrain their power. "It is worth noting that the medical industry is very professional, and corruption is very hidden, which will make it difficult for the party committee to supervise the president. For example, when hospitals purchase equipment, it is difficult to understand the doorway without more than ten years of clinical experience. In this context, if the party secretary has a weak medical background, it is difficult to effectively supervise the president. ”
He also said that there is still a common phenomenon that the president is a professional expert who has accumulated a wealth of contacts in the process of practicing medicine, which has become hidden wealth and may lead to the actual power surpassing the party secretary.
Wang Minggao, chief expert of the Hunan Provincial Clean Government Think Tank, served in the Organization Department of the Hunan Provincial Party Committee for about 20 years and participated in a large number of cadre selection work. He told China Newsweek that it is right for public hospitals to implement the system of responsibility of the president under the leadership of the party committee again, but this system is not well implemented, especially in the selection of personnel, and many places do not select the best professional experts as party secretaries.
"For example, some deputy directors of the health bureau do not understand business and lack prestige. The organization department arranged for him to go to the hospital to become the secretary of the party committee only out of the need for rank arrangement (deputy director level was promoted to chief department level), and such personnel arrangements became resettlement measures, and did not allow the party committee to play the role of a fighting fortress. ”
In recent years, the national and local levels have continued to step up efforts to rectify unhealthy tendencies in the field of medical procurement and sales and medical services.
In May 2020, the National Health Commission, the Ministry of Public Security and other eight departments issued the Notice on Correcting Unhealthy Practices in the Field of Pharmaceutical Purchase and Sales and Medical Services in 2020, which clearly and seriously investigated and dealt with the behavior of collecting kickbacks from pharmaceutical consumables enterprises, and formulated norms for medical personnel in foreign exchanges.
In November 2021, the National Health Commission and other departments issued the "Nine Guidelines for the Honest Practice of Medical Institution Staff", including legal remuneration according to work, and no commercial commission is accepted; Abide by the bottom line of communication, do not accept corporate kickbacks, etc.
In June 2022, nine ministries and commissions, including the National Health Commission and the Ministry of Industry and Information Technology, issued the "2022 Work Points for Correcting Unhealthy Practices in the Field of Pharmaceutical Purchase and Sales and Medical Services", requiring further strengthening of the supervision of violations such as "commercial bribery" and "rebates of consumables" in hospitals, in-depth management of chaos in the medical field, and punishment of "red envelopes", kickbacks and other business style problems. In the same month, Qinghai launched a special rectification campaign for medical chaos, requiring severe crackdowns on all kinds of illegal practices. In August 2022, the Guangxi Discipline Inspection and Supervision Network reported that since that year, the Nanning Municipal Commission for Discipline Inspection and Supervision has strictly corrected and investigated corruption and work style problems such as violations of diagnosis and treatment standards and irrational drug use, and has urged rectification of more than 1,100 problems, and returned more than 600,000 yuan in red envelopes, kickbacks and other funds.
Zhao Chun told China Newsweek that to further tackle corruption in the healthcare system, it should be approached from many fronts. First of all, it should be de-administrative, which is conducive to fair competition within the hospital; Second, auditing, discipline inspection and supervision commissions and other departments should improve their professional knowledge and exercise relevant powers; Third, it is necessary to increase the restraint on the power of the dean; Finally, it is necessary to improve the transparency of prices of drugs and equipment.
"Opaque prices equals information asymmetry, and hospitals may be opportunistic. After hospital procurement, it is necessary to publish the category and price on the Internet in a timely manner, which is convenient for the people to compare the drugs and equipment purchased by different hospitals. He said.
Published in the 1082nd issue of China Newsweek magazine on March 6, 2023
Magazine Title: Why Hospital Directors Are a Group with High Rates of Corruption
Reporter: Zhou Qunfeng
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