How to cut off the profit transmission chain? Storm Behind More than 2900 Criminal Judgments on Medical Corruption | Field | Corruption
A pharmaceutical anti-corruption storm, known as the "strongest in history" in the industry, is raging. Over the past few months, regulatory authorities have repeatedly expressed their determination to combat corruption in the pharmaceutical industry. Over a hundred hospital deans and secretaries have been investigated, and multiple pharmaceutical academic conferences have been postponed or cancelled.
On July 28th, the Central Commission for Discipline Inspection and the National Supervisory Commission held a mobilization meeting, deploying disciplinary inspection and supervision agencies to cooperate in carrying out centralized rectification of corruption in the national pharmaceutical industry. Just two months ago, the National Health Commission and 10 other departments jointly held a meeting to deploy a one-year centralized crackdown on corruption in the national pharmaceutical industry.
In the view of Zheng Xueqian, Vice President of the Chinese Society of Health Law, the anti-corruption work in the pharmaceutical industry is not just a temporary "storm", but a targeted approach to focus on "key areas, departments, and key personnel". Previously, she was commissioned by the National Health Commission to carry out a related project in the field of pharmaceutical anti-corruption, sorting out more than 2900 criminal judgments related to medical corruption from 2013 to 2021, and summarizing the key links, departments, and individuals in bribery related precedents.
Recently, Zheng Xueqian conducted an exclusive interview with China News Network to analyze the crux of the current corruption problem in the pharmaceutical industry and propose countermeasures.
The following is an excerpt of the interview content:
The medical anti-corruption campaign is raging
China News Network: Many industry insiders have rated this year's pharmaceutical anti-corruption campaign as "the strongest in history" and "unprecedented". In what aspects is this "unprecedented" reflected?
Zheng Xueqian: Since the 18th National Congress of the Communist Party of China, anti-corruption efforts have been continuously strengthened, and anti-corruption in the pharmaceutical industry is also an important part of the entire anti-corruption work. "Unprecedented" is first reflected in the upgrading of organizational structure. According to recent public document notifications, the number of member units of the inter ministerial work mechanism to correct unhealthy practices in the field of pharmaceutical procurement and sales and medical services has increased from 9 departments last year to 14 departments this year, with the addition of the Audit Office, State owned Assets Supervision and Administration Commission, and others.
Next is the upgrading of coordination mechanisms. The disciplinary inspection and supervision departments have collaborated to participate in anti-corruption work, forming a coordination mechanism that connects compliance, discipline, and law.
The third is to upgrade the working mechanism. The interdepartmental work mechanism for rectification closely cooperates and regularly holds joint meetings. In addition, major issues are required to be consulted and reported to the State Council.
In addition, the scope of key investigations has also been upgraded. Emphasize systematic governance across all fields, chains, and coverage, and work together upstream and downstream. For a long time, the anti-corruption campaign in medicine has mainly focused on punishing bribing parties, and this action emphasizes the supervision and investigation of bribery parties such as enterprises. Through these four upgrades, it can be seen that the Central Committee of the Communist Party of China and the State Council are determined to further improve the anti-corruption work in medicine.
China News Network: You have led a research project on anti-corruption in the medical field. Can you introduce this research? What are the important discoveries or inspirations?
Zheng Xueqian: We have reviewed over 2900 criminal judgments related to the medical field from 2013 to 2021. From the precedents of these cases, we found that the proportion of bribery and bribery in medical equipment is the highest, close to 40%, drugs account for 30%, and consumables account for nearly 20%. The bribery rate of medical devices is actually higher than that of drugs, which I think may be related to the measures taken by the government such as drug bidding and procurement.
From the perspective of key links, bribery has the highest proportion in the decision-making stage, accounting for nearly 45%, the usage stage accounting for 36%, and the procurement environment saving stage accounting for 18%.
From the perspective of key departments, the proportion of bribery and bribery actors in the administrative management department in the precedents reaches 49%, such as hospital deans, department heads, etc. Clinical departments account for 17%, medical technology departments account for 11%, and logistics systems account for 13%.
From the perspective of key groups, the proportion of corrupt leaders is 29.67%, deputy leaders are 10.43%, and the number of middle-level cadres is the highest, accounting for 40.57%. General staff account for 8.1%. Therefore, it is important for pharmaceutical anti-corruption to emphasize key links, key departments, and key populations.
Furthermore, from the perspective of the bribing party, in the analyzed precedents, private enterprises account for the largest proportion, about 73%, joint ventures account for about 17.4%, and state-owned enterprises account for less than 4%. So, it is also important to emphasize that "bribery and bribery should be investigated together".
Cut off the chain of interest transmission
China News Network: You just mentioned "joint investigation of bribery and bribery". How do you understand "joint investigation"? How to cut off the chain of interest transmission?
Zheng Xueqian: Medical anti-corruption cannot be limited to medical institutions alone, and the source of bribery is also a key focus. Enterprises themselves have the responsibility and obligation to ensure the normal purchase and sales order, reasonable pricing, and reasonable control of profit margins in the pharmaceutical industry.
In the past, the main focus of anti-corruption in the pharmaceutical industry was to punish the bribery party, with relatively small punishment for the bribery party. This time, the national level emphasizes "joint investigation", reflecting the determination of governance in all fields, all chains, and all coverage. The draft amendment to the Criminal Law, which was recently reviewed for the first time, has added new provisions to the provisions on the crime of bribery. While maintaining a high-pressure situation in punishing bribery, efforts have been made to increase the punishment for bribery.
Enterprises should strengthen the construction of credit systems, strengthen self-restraint, and establish a diversified supervision system, including the compliance department and audit department of the enterprise, as well as the diverse supervision of society.
At the same time, the country can improve the construction of a comprehensive regulatory system covering upstream, midstream, and downstream, such as establishing a unified bidding and procurement system for equipment, consumables, engineering, etc. Our previous investigation also found that centralized drug procurement has compressed the operational space for pharmaceutical corruption, but there are still links that can be further optimized in equipment, engineering, and other aspects. In addition, medical institutions can also establish corresponding reporting systems.
More than just a "storm"
China News Network: In recent years, with the implementation of centralized procurement, salary reform in public hospitals, and medical insurance supervision, the reform efforts in the medical field have been considerable. However, corruption problems are still prevalent in some regions. What are the underlying reasons?
Zheng Xueqian: Firstly, there are some policy issues, such as insufficient financial subsidies and insufficient protection for the operation mechanism of public hospitals. Especially for some grassroots hospitals, deans may take risks to maintain normal hospital operation.
Of course, there are also market factors that influence some pharmaceutical companies to pursue high profits without restrictions, continuously increasing their sales tasks, and choosing bribery and other means to achieve their goals. In addition, there are also comprehensive factors such as insufficient medical resources, inadequate hospital management, imperfect regulatory system, and lack of personal beliefs.
China News Network: Compared with anti-corruption work in other fields, what are the characteristics of regulation in the pharmaceutical industry and what are the challenges in the governance process?
Zheng Xueqian: Due to the wide scope and strong concealment of bribery in the pharmaceutical industry, the workload of investigation and punishment is relatively large.
Another important issue is how to distinguish boundaries. For example, many academic conferences have been cancelled recently, and I believe that such activities cannot be completely denied because the improvement of medical technology requires a platform for communication. The key lies in how to reasonably define whether it is an academic activity or a disguised benefit delivery, which is a major challenge in the governance process.
China News Network: From the current centralized rectification of corruption in the pharmaceutical industry, what are the key areas of supervision and how can we avoid the phenomenon of "gusts of wind"?
Zheng Xueqian: This action is not intended to create a temporary storm in the pharmaceutical industry, cracking down on a large area, but to emphasize the focus on key areas, key departments, and key minority individuals, establish a long-term professional ethics mechanism, and improve a diversified regulatory system.
To put it bluntly, the focus of regulation is twofold: first, personnel management, which refers to key positions and a few key individuals; second, management, which refers to the entire field, chain, and coverage. By increasing the intensity of legal penalties, people are encouraged to "dare not be corrupt"; By establishing a sound system, people cannot be corrupt; Through education, make everyone "not want to be corrupt".
China News Network: How to establish a long-term regulatory system in this field in the future?
Zheng Xueqian: We should improve China's medical and health legal system, promote the construction of hospital legal system, for example, clarify the functional positioning and operating mechanism of medical institutions, clarify the functions of public hospitals, for-profit hospitals, and non-profit hospitals, as well as how to charge fees, operate them, and ensure their operation.
At the same time, we need to improve the modern management system of hospitals, implement reform policies in place, and deepen reforms to reflect the public welfare and state-owned nature of public hospitals, as well as the special nature of the medical industry. We need to ensure the normal operation and expenditure of public hospitals, and block the drawbacks of the business model that pursues economic profit maximization unilaterally under the influence of the market economy from the perspective of institutional mechanisms. This is the direction of efforts for the high-quality development of public hospitals in the future.
Secondly, the root cause of medical corruption should be cut off, such as establishing a unified bidding and procurement platform for equipment, consumables, etc.
In addition, it is necessary to strengthen the construction of the professional ethics system and form a comprehensive long-term mechanism. For example, incorporating professional ethics construction into the central work of medical institution management, system administrators, regular training and assessment, and improving professional ethics norms and systems.
Finally, it is necessary to improve the diversified supervision and management system, apply new technologies to the supervision system, establish an information network, and achieve information sharing, transparency, and openness.
