China: Government Murders Hospital

China: Government Murders Hospital 2023.08.13 No.255

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Recently, the anti-corruption campaign in the field of medicine is gaining in force. In mid-July, the National Health Commission of the PRC held a meeting to deploy a one-year project focused on corruption issues in the field of medicine. Before the end of July, the leniency of those who voluntarily surrender; the remaining ten months, focus on remediation. On July twenty-eight, the Central Commission for Discipline Inspection of the CPC (CCDI) and the National Commission of Supervision of the PRC (NCS) held a mobilization meeting which requires the discipline inspection and supervision institutions to cooperate with the remediation. Before, similar documents or meetings against corruption in the field of medicine were not uncommon, but after July twenty-eighth, the anti-corruption campaign is escalating into a strong storm. There are media reports that recently there have been a number of provincial and municipal health commissions that have published reporting telephone numbers. Among them, the Beijing Municipal Health Commission issued a notice, stating that it would first of all announce the reporting phone number and other information to the whole society during the period of remediation; the Shanghai Municipal Health Commission issued a similar notice. Some media comments that this anti-corruption campaign in medicine is unprecedented in depth, breadth and strength. During this period of time, there are people being investigated every day. In three weeks, about thirty deans, directors, and party secretaries of hospitals have been investigated. There are more reports of department heads, and even some doctors, who are being investigated, or voluntarily surrendering. For most of those engaged in the field of medicine, it is almost to the point of panic. This is because systemic corruption exists in the field of medicine and corruption is prevalent even among ordinary doctors, not to mention the directors and party secretaries of hospitals. Recently, an online news tells that a famous surgeon’s house was being searched and it was fund out that his assets amounted to one hundred and fifty million yuan, in addition to twenty flats and thirty kilos of gold. Another official report says that the director of the First People’s Hospital of Yunnan Province owned more than one hundred flats and one hundred parking spaces, and was called the “Double Hundred Director”. Probably, he has more than one billion yuan in total assets. Invariably, such huge wealth comes from their patients. Eight years ago, Professor Li Ling, director of the China Health Development Research Center at Beijing University, once said, if the factory price of a medicine was one yuan, the consumers would have to pay one hundred yuan for it. Bribery in the field of medicine has always been an “open secret”. Ten years ago, the Beijing News reported that, while the factory price of a medicine was only fifteen point five yuan, the hospital would sell it at two hundred and thirteen yuan. The hospitals’ profit was only ten percent or so, while the rest of the profit would go to corruption. In two thousand and eight, the total national medical care expenditure was one point two trillion yuan; the figure rose to more than seven point five trillion yuan in two thousand and twenty-one. And, most probably, this figure only includes public funding, excluding patients’ private funding. It is difficult to tell how much of this tremendous amount money went into the pockets of hospital directors, party secretaries and doctors. Corruption in the medical field, so to speak, has a long history. The fact that the people cannot afford to see a doctor is certainly a problem of government policy, but the corruption in the medical field has increased the people’s burden and led to conflicts between doctors and patients. Excessive medical treatment, indiscriminate prescribing of medicines, even deliberate misleading and deceiving of the patients by doctors have led to public dissatisfaction. In fact, the whole population suffer from difficulty in seeking medical treatment and high cost of medical care. Why is it that for so many years the people’s appeals have got no response, while this year, the top authority have suddenly made a big fuss over it?

What immediately comes to one’s mind is that the government has run out of money. Financial pressure forces them to extract wealth from the medical field in the name of an anti-corruption campaign. This is surely an important factor. However, there may be other reasons. Recently, the domestic economy has been in the doldrums, and consumption, which is one of the three driving forces of the economy, is even more sluggish. The government has made great efforts to boost consumption, but there is no sign of improvement. The most fundamental problem is that the people’s livelihood lacks protection, and they dare not spend money even if they have money. More people are falling into poverty, and they simply do not have money. Many have called for a universal free medical care, so that the people can consume without too many worries. The people in poverty, more than anyone else, demand for free medical care. Recently, free medical care has once again become a topic of heated discussion.

It is noteworthy that, a few days ago, Yi Cai, a widely influential media in China, published an article by its reporter, as an official response to public appeals. The article is entitled “Why is our country not suitable for free health care? Constrained by these conditions”. It says that there is no free lunch in the world, and what is free will not be the best. The implementation of “free medical care for all” is not suitable for China’s national conditions, and free medical care will, to a certain extent, lead to a pressure on resources and make access to medical care even more difficult. The article also mentions India in particular, saying that their free medical care and public hospitals are in poor conditions, and that they have only three hundred and forty-eight kinds of free medicines. The implication of this article is that China cannot adopt the policy of “free medical care for all”, and other countries which have adopted this policy also suffer from poor medical conditions. There is nothing new in this article, as the relevant authorities have said similar things many times. In spite of that, the people simply do not believe in the reasons they give, and many experts and scholars have also refuted them. In fact, as we all know, officials of the CPC, especially senior and middle-ranking officials, are provided with free medical care, and they enjoy the best treatment. As early as two thousand and nine, the former Vice Minister of the Ministry of Health revealed that eighty percent of the medical expenses invested by the government were only enjoyed by party and government officials. This long-existing inequality has aroused great discontent in society.

Perhaps the authority was a little guilty of this, and on August eleventh, the Xinhua News Agency issued an article declaring that the wards for senior officials should not be abolished, and that appropriate medical treatment should be provided to those who have worked hard and made great achievements. This is actually a response to the public appeals for universal free medical care. The article of the Xinhua News Agency declared that the setting up of high-official wards was due to the recognition and care for those who have worked hard and made great achievements. They have made great contributions to the state and society, and have toiled. They have gone through arduous work and pressure, and have assumed enormous responsibilities. Therefore, giving them proper medical protection and high-quality treatment condition is not a luxury or a privilege, but a reward and consolation for their hard work. But the problem lies in that, when many ordinary people are unable to secure even the minimum free medical care, it is unacceptable allowing senior officials to enjoy super-class medical services. The authority has repeatedly claimed that free medical care for all is financially unaffordable. As a matter of fact, with the right policies and careful management, the government only needs to invest one extra trillion yuan, and that is enough to initiate a universal free medical care project.

Considering the on-going anti-corruption campaign, suppose that all the relevant persons must go through the anti-corruption investigation with no one exempted; in the whole country, there are more than three thousand class three hospitals, that is top hospitals, and there are more than ten thousand class two hospitals; there are hundreds of thousands of departments in these hospitals; the vast majority of these hospitals are public hospitals, and all of them are corrupt in some way. Now that nearly all the deans, party secretaries and directors in charge of these hospitals and departments are involved, the government can easily collect several trillion yuan from them, or even more. Besides, there are about ten thousand private hospitals. Since these private enterprises are under the supervision of local health departments and health bureaus, private owners have to bribe the heads of these institutions, as well as the heads of the powerful sections within these institutions. The heads of the health departments of more than thirty provinces and municipalities, plus the heads of the health bureaus of three hundred prefectural-level cities, plus the heads of the powerful sections within these institutions, such a tremendous group involved may also contribute a few trillion yuan. And there are six to seven thousand large and small pharmaceutical factories, where corruption problem is no less serious than that in the hospitals. So, it will not be too difficult to collect a few trillion yuan from them. If the authority’s anti-corruption campaign had not been aimed at making up for the financial shortfall, the money collected would have been enough to initiate a universal free medical care project.

Of course, the on-going campaign is obviously not just aimed at the medical field alone; its arrangement gives consideration to the macro picture. It can be said that this campaign, in addition to the opportunity to enrich the government, is intended to cope with the critical situation of the moment. At a time of consumption downturn, with the people trapped in poverty, the authority launches this campaign to cope with the people’s call for free medical care, to divert public attention and to get rid of its own responsibility. They are trying to convince the people that the difficulty and high cost of seeing a doctor is mainly the result of corruption in the medical field. Obviously, this is not a campaign against corruption; it is political deception. This is precisely the main reason for the authority to make a big fuss. It is possible that, after this anti-corruption campaign, the people’s medical care costs will be reduced, thus lowering the people’s discontent and appeasing public anger.

But the real cause of the difficulty and high cost of seeing a doctor lies in government policy: the government has invested too little in the people’s healthcare. In public hospital fundings, state allocation takes less than five percent, which is not even enough to pay for the hospitals’ utility bills. The government then allows the hospitals to maintain their operations through their own profits, thus giving opportunities for corruption. The problem of systemic corruption is definitely not something that can be solved by arresting a few deans, party secretaries and doctors. The problem of corruption in medicine is only the tip of the iceberg. Under the existing system, the problem of corruption in medicine can by no means be eliminated. Moreover, even if appropriate and effective policies are formulated, without an open monitoring mechanism, any policy will fail.

Many people suspect that the anti-corruption campaign in medicine is only intended to enrichment the government. It is precisely for this reason that some people have expressed doubts and worries. The director of a top hospital gave his opinion online: “Look at those who are being arrested now, except for the deans, all the rest are heads of various departments, including some deans who are specialists in various disciplines. Why don’t you get to the root of these problems? This campaign, if not handled properly, could lead to a total collapse of our national healthcare system.” Even Hu Xi-jin expressed his concerns, being worried that something was running off the rails, although his suggestion was no more than some politically correct nonsense.

Apart from the selfishness of the authority, the lack of competence and proper governance is also a major reason for such a mess in China’s medical field. The main group of people who offer bribes to hospital directors and doctors are the so-called pharmaceutical representatives, numbering as many as three million. According to information on the Internet, in the past five years, the sales cost of the pharmaceutical industry amounted to one point fifty-five trillion yuan. Probably, this is only the figure publicly provided by large enterprises. As for the small and medium-sized pharmaceutical companies, the sales cost will be even higher. There are six to seven thousand pharmaceutical factories in China, and many of them produce the same products. Local governments’ duplicated investments and duplicated constructions result in so many pharmaceutical factories. Without any technological advantage, they can only sell their products through bribes. Those bribe-paying sales representatives actually represent local governments, state-owned enterprises and employees. They are not committing crimes for themselves. In fact, China only needs a few dozen pharmaceutical factories. Nevertheless, local governments, in order to increase fiscal revenue, compete to establish their own pharmaceutical bases, resulting in serious overproduction. The important reason behind this lies in the ruler’s lack of the minimum ability to govern the country, especially lacking the ability to manage the economy.

The problem of corruption in medicine has existed for more than a decade or decades, and the public has expressed extremely strong dissatisfaction. However, until now, there has been no improvement. The reason is that the rulers do not feel any real pressure. If such a problem were to occur in a democratic country, the ruling party would surely have to resign. The biggest problem with the CPC regime is that it has very strong controlling capacity, while it is totally incapable of governance. As an absolutely dictatorial political party that has been in power for several decades, it is still unable to form a large, unified market across the country. The chaos in the field of medicine is just a microcosm of the overall chaos and disorder in the whole country. The field of medicine is not the only sector plagued with serious problems. In fact, there is not a single line of business in China that can go the right way.

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