The Nanjing prosecutor suggested that a disciplinary mechanism should be established to form an early intervention against corruption.
Yao Wen/painting
Drug rebates embezzle state assets by 772 million yuan every year.
In many hospitals, almost all clinicians and department directors are involved in obtaining kickbacks from doctors’ prescriptions, and accepting kickbacks from drugs has become an open unspoken rule.
Some hospitals collectively accept kickbacks, and if they are severely punished according to law, the whole department will be paralyzed.
In recent years, job-related crimes in the medical and health system have shown a high incidence. According to the data of the Ministry of Commerce, as a commercial bribe, drug kickbacks embezzle 772 million yuan of state assets every year, accounting for about 16% of the annual tax revenue of the national pharmaceutical industry. A few days ago, the Gulou District Procuratorate of Nanjing and the Institute of Crime Prevention and Control of Nanjing University conducted a special investigation on the phenomenon of duty crimes in the medical and health system.
"In order to deeply analyze the causes of corruption in the procurement of drugs, medical equipment and medical consumables, we randomly selected 11 cases investigated by Nanjing procuratorate in the past three years and conducted in-depth and detailed investigations." Tian Yuechu, procurator-general of the Gulou District Procuratorate in Nanjing, told reporters.
It is not easy to send a case, and it is even more difficult to handle it.
Bribery forms a community of interests, and the symbiotic relationship is difficult to break. "From the 11 cases we investigated, taking kickbacks has become a collective unconsciousness in some hospitals, and the hidden rules are hard to break." Ge Bing, deputy procurator-general of Gulou District Procuratorate, said. For example, Zeng, deputy director of the clinical laboratory center of a hospital, said that in the process of reagent procurement, their department first lowered the price, then privately raised the price by 12%, and 5% of the 12% price increase was returned to the department, and the drug supplier got 7%. This kind of interest community relationship is difficult to break. At the same time, a briber may involve more than 10 bribers, and a briber may also bribe many people in the hospital. Because every drug dealer takes bribing the relevant personnel in the hospital as the main means to promote sales, kickbacks of various drugs are common in hospitals. Doctors get kickbacks from prescriptions, which involve almost all clinicians and department directors, and are often intertwined. Therefore, in the medical system, accepting drug kickbacks has become an open hidden rule. Just as a hospital director said confidently after being arrested, "Everyone did this, so when the supplier told me that he would give me money properly, I didn’t take it seriously and agreed."
Most of the people involved are professional experts and it is difficult to deal with them. Some medical staff who accept kickbacks are mostly experts in the business of their hospitals or departments. They are the pillars of hospitals or departments and it is difficult to deal with them. Among the investigated cases, the hospitals in three cases asked the judicial organs to give them a lighter or lighter punishment, or even to be exempted from criminal punishment. For example, after the president of a hospital committed a crime, 28 medical staff in the hospital signed a letter asking for a lighter or lighter punishment.
Medical duty crimes have the characteristics of mass, and there are many cases in succession, which increases the difficulty of cracking down. For example, a department of a hospital collectively accepts kickbacks, with as many as 10 people. If it is severely punished according to law, the whole department will be paralyzed, so it is difficult to deal with a wide range; Among the 11 cases investigated, 8 cases (72.7%) found clues by relying on anonymous or real names of the masses. Because bribery and bribery are conducted in private, it is difficult for outsiders to find their criminal acts, and because they have a community of interests, they will not report them themselves, which makes it more difficult to solve the case.
Bad system and poor self-control ability are the key to corruption.
"After all, the medical system is not a typical public power. Therefore, compared with other public power departments, the wind of corruption in the medical system is late, but it is very fierce." Di Xiaohua, director of the Institute of Crime Prevention and Control of Nanjing University, said. He believes that this phenomenon is caused by patients and suppliers, but the key is the unsatisfactory medical system and the poor self-control ability of hospitals.
For patients, it seems to be a "habit" to send red envelopes to doctors. According to a doctor, giving red envelopes to patients mainly occurs in hospitalization, especially in the process of surgery and using anesthetics. In order to reduce the risk of surgery, patients always hope to invite experienced doctors to perform the surgery. In the case that the hospital does not openly let patients choose doctors, private transactions between patients and doctors are inevitable. The wind of giving red envelopes to pay bribes has gone through three stages: in the first stage, the family members of patients took the initiative to pay bribes before the operation, but most doctors refused; The second stage is not to accept before the operation, but some patients will no longer refuse to thank their families after the operation; In the third stage, more and more people send and more and more people receive, and receiving red envelopes has become a hidden rule within the hospital. The widespread acceptance of red envelopes makes patients feel uneasy about not sending them, while the widespread acceptance of red envelopes makes it difficult for more doctors to resist the temptation. So sending and receiving, and sending are getting worse and worse, becoming more and more common.
For suppliers of medicinal materials, medical equipment and consumables, hospitals are always the biggest users, and the selection and usage of medicines, medical equipment and consumables in hospitals mainly depend on doctors, so savvy suppliers put the focus of sales promotion on the main doctors in departments. At first, we just sent some small gifts such as calendars, phone cards and shopping vouchers, and then got kickbacks according to the actual usage. Later, it developed into sponsoring overseas study tours, attending seminars and paying consultation fees. Suppliers and sellers destroy the ideological and moral defense line of medical workers bit by bit, and finally capture them, so that they are willing to contribute to their own prosperity. For example, Jiang, a doctor in a hospital, revealed that 70% of the drugs in the hospital pharmacy have kickbacks, among which antibiotics have a higher rebate rate, such as "Yi Fu Xin" rebate for each 2.5 yuan, "Bu Fu Re Xue" rebate for each 7 yuan, and "Tefumeng" rebate for each 15 yuan, etc. These rebate rates are all above 15%. As a result, in order to obtain high profits, doctors can get a good cold with a few dollars, and patients have to spend hundreds of dollars. However, some doctors hold kickbacks ranging from several hundred yuan to nearly ten thousand yuan every month.
"No matter patients or suppliers, they will not willingly give their money to others. The occurrence of corruption has a lot to do with our medical system and hospital management." Di Xiaohua said.
According to the investigation report, the problems existing in the current medical system are mainly manifested as "insufficient medical investment and serious phenomenon of supporting doctors with medicine". For a long time, the proportion of government investment in state-owned hospitals has been declining year by year, and hospitals have to survive. The state allows medical units to increase hospital expenditure compensation by earning the difference between wholesale and retail prices of drugs. The system of "supporting doctors with drugs" is widely implemented in medical units, and drug profits generally account for 50% of hospital income, and even reach 80% in primary hospitals. In order to increase income, hospitals often conclude comprehensive target responsibility letters with departments, and reward them at the end of the year according to the proportion of medical business income completed by each department throughout the year, but seldom ask about the construction and evaluation of doctors’ medical ethics. In order to increase medical income and get a higher year-end reward, all departments of the hospital have over-examined and improperly treated patients. For example, the president of a hospital signed a comprehensive target responsibility letter with nearly 30 departments and departments of the hospital to determine the one-time reward standard of the hospital department according to the proportion of medical business income. Results In 2004, the laboratory department of our hospital completed medical business income of 3.96 million yuan, and the one-time reward of the hospital was as high as 79,200 yuan, while the urology department completed 2,870 outpatient and emergency visits and discharged 24 people, and completed medical business income of 112,000 yuan, only receiving a one-time reward of 2,800 yuan. This profit-seeking distribution incentive mechanism will inevitably lead doctors to use medical relations for corruption.
However, the poor self-control ability or management ability of hospitals is mainly manifested in the following aspects: the decision-making power and the right to use pharmaceutical devices are not separated, and the procurement sponsorship is not strictly regulated.
In the investigation, some hospitals do not have organizations such as drug and device purchasing group and pharmaceutical affairs committee, and even if there are similar organizations, they do not play their due role in restraint and supervision because of the lack of standardized procurement procedures. Hospitals or departments negotiate with the relevant units for "kickbacks" in advance, and other tenderers are just "foil", which leads to the bidding being just a formality. For example, The procurement process of the reagent group in the clinical laboratory of a hospital is as follows: firstly, the staff who need to purchase the specific working films (note: the laboratory is divided into three films: immune film, biochemical film and blood film) orally submit the procurement application to the department leader-reagent group discussion (mainly composed of the director of the laboratory department, the director of the film and a secretary). -Hold a competition meeting for each manufacturer-The latter will send reagent samples and be numbered-Biochemical films of the clinical laboratory will identify the selected samples-Take the top three, and negotiate with the top three to determine the manufacturer with the lowest price-Put forward a tendentious opinion and report the procurement report to the hospital equipment department in writing-The equipment department will sign a contract and pick up the goods. The evaluation of bidding by the reagent team of undergraduate course room is obviously not in conformity with the provisions of bidding procedures.
Procurement accepts sponsorship, which is a subordinate behavior of commodity procurement, commodity procurement is the main relationship, sponsorship is the subordinate relationship, and the latter is established to achieve the former. It is a subsidiary condition of the main behavior, so it is tempting, can form a competitive advantage, and may become a sales promotion means to crowd out competitors. Accepting sponsorship in the process of purchasing will bring burden and confusion to normal business operation, and it will distort the efficiency competition that should be based on factors such as commodity quality, price and service, so it is a disguised bribery. At present, there is no special law to regulate sponsorship in procurement in China. The source of sponsorship, in-kind or cash sponsorship need to be clearly defined by law, and disguised bribery should be severely cracked down to prevent sponsorship from becoming another new form of bribery.
Curbing duty crimes in the medical system has a long way to go.
In recent years, job-related crimes in the medical system are on the rise, and how to deal with them has become the most concerned topic. Experts on crime research believe that if crime is compared to a pot of boiling soup, the blow is to raise the soup to stop boiling, while prevention is to take the root cause of the problem. Strike is a punishment for criminal acts, and it is a palliative; Prevention focuses on preparing for a rainy day, nip in the bud, which is the fundamental solution.
-standardize drug use behavior and improve drug use management regulations. The informed consent system of drug use can be established in the hospital, the drug price can be announced, and some drugs can be listed for patients to choose without affecting the curative effect; The hospital regularly checks the variety and dosage of drugs every month, and makes a good registration, and investigates the drugs and dosage ranked in the top three for three consecutive months and posts them on the wall for the supervision of all medical staff and the people; The hospital should deal with the medical staff who are badly reflected by the masses in time, so as to solve the tension between doctors and patients.
Second, reform the distribution system to eliminate the dependence of income on medicine.
In view of the comprehensive target responsibility letter signed between the hospital and the doctor, when the doctor’s salary and bonus are linked to the doctor’s dosage, it will inevitably lead to over-examination and over-treatment of medical staff. Only by reforming the existing distribution system and completely eliminating the link between doctors’ income and the use of drugs and medical devices can this phenomenon be fundamentally overcome. Because the distribution system in China has not reached the point of "from each according to his ability to get what he needs", we can only implement "distribution according to his work". At present, we can consider the distribution method of linking the doctor’s income with the amount of medical treatment on that day, and taking medical ethics evaluation and other factors into account comprehensively, so as to eliminate the dependence of the doctor’s income on the variety and dosage of medicines from the source.
Third, establish a disciplinary mechanism to form an early intervention in corruption.
Sixteen people involved in these 11 cases are first-time offenders. After committing crimes, they can truthfully explain their criminal acts and actively return the stolen goods, which shows that they are not bad in essence. As long as the relevant departments intervene in advance, they can completely avoid committing crimes. By improving the internal procurement and distribution system listed above, the self-control ability of the medical system can be improved and the duty crimes of the medical system can be reduced. If there are still medical personnel who violate the relevant regulations of the hospital, the hospital can formulate some strict rules and regulations (such as qualification punishment) to punish those who violate the law and discipline. For some disciplinary personnel, it can be stipulated that they will be transferred from medical posts for half a year; For some serious violations of the law, the doctor’s license can be revoked until the doctor’s qualification is revoked for life. In this way, an early intervention mechanism within the hospital can be established to truly stifle corruption within the medical system, so that the violators will not continue to go into the abyss of crime.
Fourth, deepen structural reform and increase capital investment.
Strengthen state funding for state-owned hospitals. At present, China’s insufficient investment in medical institutions has objectively caused the occurrence of duty crimes among medical workers, departments and hospital leaders. Therefore, it is necessary to effectively increase the investment in non-profit organizations of state-owned hospitals, including salaries and scientific research funds, and gradually raise the salary level of medical staff appropriately to overcome the unbalanced psychology of medical staff. Only in this way can we overcome the strange circle of "taking medicine to support doctors" in hospitals, let medical workers really settle down and resolutely refuse to accept red envelopes, and at the same time, separate medicines from drugs, separate drug management from hospitals, and at the same time properly raise the price of medical services.
(Cui Jie Xiao Shuijin Gu Lijuan)
Editor: Gao Song
