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Moving towards a better path? A mixed-method examination of China’s reforms to remedy medical corruption from pharmaceutical firms
  1. Jianwei Shi1,2,
  2. Rui Liu1,
  3. Hua Jiang3,
  4. Chunxu Wang4,
  5. Yue Xiao4,
  6. Nana Liu4,
  7. Zhaoxin Wang1,4,
  8. Leiyu Shi2
  1. 1 Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
  2. 2 Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3 Department of Family Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
  4. 4 Tongji University School of Medicine, Shanghai, China
  1. Correspondence to Dr Zhaoxin Wang; supercell002{at}sina.com and Professor Leiyu Shi; lshi2{at}jhu.edu

Abstract

Objectives Few studies have systematically examined the effects of the existing regulations for alleviating corruption in China. This study assesses the effectiveness of China’s reforms to curb medical corruption.

Methods We used mixed methods for the evaluation of existing countermeasures. First, qualitative informant interviews based on the Donabedian model were conducted to obtain experts’ evaluation of various kinds of countermeasures. Second, using data from ‘China Judgements Online’, we analysed the trend of occurrence and the characteristics of the medical corruption cases in recent years to reflect the overall effects of these countermeasures in China.

Results Since 1990s, China has implemented three main categories of countermeasures to oppose medical corruption: fines and criminal penalties, health policy regulations, and reporting scheme policy. Information from the interviews showed that first the level of fines and criminal penalties for medical corruption behaviours may not be sufficient. Second, health policy regulations are also insufficient. Although the National Reimbursement Drug List and Essential Drug List were implemented, they were incomplete and created additional opportunities for corruption. Moreover, the new programme that centralised the purchase of pharmaceuticals found that most purchasing committees were not independent, and the selection criteria for bidding lacked scientific evidence. Third, the reporting scheme for commercial bribery records by the health bureau was executed poorly. In addition, quantitative online data showed no obvious decrease of institutional medical corruption in recent years, and most criminals have been committing crimes for a long time before getting detected, which further demonstrated the low effectiveness of the above countermeasures.

Conclusions Although existing countermeasures have exerted certain effects according to Chinese experts, more rigorous legislation and well-functioning administrative mechanisms are needed. Fundamentally, financial incentives for hospitals/physicians and the health insurance system should be improved.

  • medical corruption
  • evaluation
  • effectiveness
  • China

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors Conceived and designed the experiments: JS, ZW and LS. Analysed the data: JS, RL and CW. Contributed reagents/materials/analysis tools: HJ, YX and NL. Wrote the paper: JS and LS. Revised the paper: JS and LS.

  • Funding The design of this study was financially supported by the Shanghai Health Policy Program (2016HP043). Data collection, analysis and interpretation were funded by the Key Developing Disciplines of Shanghai Municipal Commission of Health and Family Planning (2015ZB0602) and the International Postdoctoral Exchange Fellowship Program (2017(32)), and the writing and revision of the manuscript was funded by the Natural Science Foundation of China (71603182).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All research activities were conducted with integrity and in line with generally accepted ethical principles.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All relevant data from the ‘China Judgements Online’ can be shared to the public.