Medical network - March 31, the people's procuratorate in yuexiu district of guangzhou recently wrote a research report on the medical corruption, 25000 words, probed into the medical duty crime rises year by year. 

 

The report was based on 2010 ~ 2016, the people's procuratorate investigation of the 66 medical and health field duty crime cases, involving 66 people. "China news weekly" get the has not been officially released the medical consumables duty crime investigation report. According to the report, in the field of medical duty crime presents some new characteristics in recent years, such as forms of corruption by a single secret commit crime to type organized collective corruption, involved link to medical consumables procurement from drug distribution link, ordinary staff involved by the medical and health system to high-end professional medical personnel. 

 

"As prosecutors, on the one hand, we must combat corruption; on the other hand, we also want to understand, why after the blow and new cases appeared, can play a good effect on pure fight?" Anti corruption bureau deputy director in yuexiu district of guangzhou city people's procuratorate Xie Lianshen explained to "China news weekly" the cause of the subject research. 

 

Case, the string case increased 

 

The national health system situation of frequent occurrence of corruption is to research the background of yuexiu district people's procuratorate. According to incomplete statistics, since 2014, the country announced by a corruption of the lok ma the hospitals at all levels of the dean (contain deputy dean) at least 183 people. 

 

It is a trend reflected in guangzhou yuexiu district people's procuratorate of the same report. From 2010 to 2010, the yuexiu district people's procuratorate, a total of 1 piece of duty crime seized the medical field, the remaining 65 cases in 2013 to 2013. Among them, only in 2016, in guangzhou yuexiu district people's procuratorate investigation of the case, occurred in the field of medical and health care cases accounted for 37.9%. 

 

From the beginning in July 2016, the yuexiu district people's procuratorate Su Ming (a pseudonym) is involved in the project. His main work is to review and summarize statistics, case. He found that, with increasing trend, the case also presents new characteristics. "A few years ago the handling is a case that involves the individual doctor or logistical service personnel, and now, in most cases are litter or string." 

 

"Nest" and "string" is a commonly used term's procuratorate. In medical duty crime, nest case often involves a hospital or department level of managers and staff; While the string case involving medical institutions and a number of staff. 

 

Has made a nest Su Mingju case example. A hospital in case, engage, director of the department of cardiology, the subordinate common accepting kickbacks: first by the director and the agents negotiate good rebate percentage, and shall be the responsibility of the deputy director of the levy kickbacks to contact each other regularly, the department is involved in two other attending surgeon distribute. In order to play the role of mutual supervision are exposed, deputy director of the department, along with two of the attending physician to drive to pay sites in the briber conventions, jointly participate in specific charge process. "The reason is that it is the individual corruption is difficult to escape from the restriction of the supervision mechanism, in order to achieve the purpose of corruption, corrupt corruption only by forming small groups, in the form of collective corruption erosion existing supervision mechanism, to a broader, deeper corruption." Yuexiu district people's procuratorate such analysis in the report. 

 

Medical duty crime tend to be complex. In further review, Su Ming and others found that the case not only involves the combination of hospital internal corruption, also involves other several hospitals in guangzhou and further form a "string". The briber not send money to the director of the hospital, also gave several other hospital." 

 

Bribes are changing. Traditional medical corruption is given priority to with rebates, rebates, generally there are two, one is based on product sales in proportion to the total amount of 10% ~ 15%, quarterly or half-yearly kickbacks to see the doctor, the second is to give a certain amount of calculation using a single product commissions. 

 

But after the analysis of the cases in recent years, prosecutors found that bribery and way of names, from a pure form of money, the transition to the interests of the other property delivery, including agency chamber of commerce to festival bonus, labor, finance meeting travel, sponsor academic activities and issuing paper gives doctors a variety of related economic interests. 

 

"At first, the agent may not blatant cash rebates, but offer a variety of economic benefits and convenient life, such as transfer, meetings, on the way to treat such as ticket booking, holiday party, and the economic benefit is more concealed, investigate difficulty also increase accordingly." 

 

For such hidden corruption, the doctors involved in the general lack of a clear understanding. Su Ming says, "some doctors can even to the procuratorial organ reflection, 'I accept business unit sponsorship of the most used to print some information meeting, invite experts to lecture to pay dollars, etc., I'm in it for the department of development and academic progress, how illegal crime?'" 

 

Consumable materials into new corruption 

 

In yuexiu district people's procuratorate of the medical and health field job class crime case, 2010 years ago, illegal behavior occurs mainly in drug distribution. 

 

Starting in 2013, the yuexiu district people's procuratorate found that medical and health field duty crime has a change trend from drug link to medical consumables. Especially in 2016, the yuexiu district people's procuratorate is dealt with by the relevant cases had occurred in the field of medical consumables, in the past, people may pay more attention to corruption in the field of procurement, and now find use in the field of a bigger problem. "This trend represents the involved medical corruption interest chain behind refactoring", yuexiu district people's procuratorate to remind the outside world to realize the change. 

 

In yuexiu district people's procuratorate to investigate and punish the cardiovascular consumables on corruption cases, prosecutors found that involved the use of medical workers for consumables has bias, "in the use of consumables, some doctors will accordingly varieties of consumables, also some doctors tend to use habits of the product." 

 

It is worth noting that to enter the purchasing process of medical equipment, such as heart stents did not stipulate the period in which to use. This means that the agent once received a hospital one or several medical consumables purchase approval, can be long-term supply to a hospital. They in order to maintain the long-term business relationship to the medical staff. It is formed a medical representative by bribing get long-term supply to the hospital, the doctor strongly recommended that a vicious cycle of patients with long-term use. 

 

There will be induced patients using the behavior of medical consumables. Famous cardiologist, director of the cardiovascular disease branch of Chinese medical association member of cummins p. cardiac-specific troponin was mentioned in the interview, the doctor will induce the heart bypass patients with stent implantation. "Some doctor will say to the patient, a bypass to open chest, put a stent small trauma, you will decide." He admits, in general, there are very few patients need to put more than three heart stents, but our country has a lot of patients were more than 10. 

 

Cummins p. cardiac-specific troponin said, choose to bypass or bracket, should be after cardiology and cardiac surgery expert consultation, according to the specific condition to decide. Internationally, stents and bypass surgery is 7:1 ~ eight-to-one, but in China, the proportion is as high as now. 

 

In the field of medical consumables were able to highlight problems elsewhere in the country. In 2013, mudanjiang northeast procuratorial authorities seized nine cities in the medical and health fields, with 60 cases of duty crime, 66 people, the amount involved more than 900 ten thousand yuan. According to the local prosecutors, there are 36 cases occurred in medical equipment purchasing, accounting for 60% of the total project cases. There are 18 cases happened in the film procurement procedures; Only 3 cases occurred in drug purchase link. 

 

The transition of the duty crime link in medical areas comes from the Chinese government policy in the field of drug circulation. Since 2000, China began to explore the implementation of the drug centralized bid procurement system, fully implementing the government-led, units of provinces, autonomous regions and municipalities directly under the online drug centralized purchasing. Guangdong province in 2007 for the entire province medical institutions and drug centralized purchasing net price and bidding method, to some extent this specification of drug purchase behavior of medical institutions and drug firms and orderly competition. Since then, the yuexiu district people's procuratorate for involving in the field of medical duty crime began to change direction. 

 

Team to attribute this to the benefits of system design. And medical consumables field just lack of similar design. Hospital for medical consumables used the lack of regulation, is the important reason for the consumable field corruption happens. In guangzhou, the purchase of medical consumables, is still a separate bid procurement, namely according to the clinical departments use demand, the hospital QiXieKe bargaining negotiations with suppliers, as planned purchase formalities. 

 

To this, according to the report, "although the hospital itself also has a set of procurement process, but the lack of external supervision and internal formal management still make corruption there is a big space, combined with the medical consumables itself value is bigger, has the recessive cost, the hospital of specialized subject doctor of consumables used with a voice, for medical equipment and consumables has created instead of medicine the best means of profit, increase the risk of the link of the duty crime." 

 

In fact, as early as the second half of 2009, price bureau of guangdong province in the province to carry out the medical apparatus and instruments, medical consumable price special research has found that, in 2008, the survey by the medical institutions use of cardiac pacemakers, lumen amount and type of stent patch significantly more than in 2007. The same is soaring prices. Its subsequent report, according to the price of medical consumables management research in the production process, some production enterprises in 2007, 2008, the production of the top ten medical consumables the actual average ex-factory price of more than 70% higher than the product cost. 

 

In team's view, institutional incompleteness of the profits as well as the medical consumables are the root causes of corruption. In a meeting with the hospital, they found that hospitals to prevent position crime in the field of medical consumables, are making a lot of measures, especially for key link such as brand and price two measures for risk prevention and control. "Every hospital procurement for risk prevention and control in accordance with its own characteristics, has also led to the provincial hospitals individually, without a unified specification." Su Ming said. 

 

"Three highs" main personnel into corruption 

 

With the transition of the nature of the case, the team found that the staff involved in medical and health system is carried out by staff of the ordinary to high-end professional medical personnel. "The medical staff involved in the group showed higher administrative levels, high degree, high professional influence of the" three highs "characteristics." 

 

2014 years ago, the yuexiu district people's procuratorate investigation of the medical corruption both mainly concentrated in the inspection department, logistics department, construction department, and other fields, the department of the staff involved in the record of formal schooling and professional requirement is relatively low. Now, the leader of the industry, director of the level of medical staff in the field of medical occupy the vast majority of those involved. "The doctors involved in the field has the high professional influence, at the same time engaged in administrative management, health care, education and scientific research work, many of them are college tutor." 

 

Procuratorate anti-corruption bribery bureau trial of a criminal suspect, was a university affiliated hospital, director of cardiology, cardiovascular interventional diagnosis and treatment work more than 20 years, to undertake or participate in national, provincial and internal topic more than 10 items, has more than 30 papers as the first author, has very high achievement in academic. "Because of the relatively large social resources, the low level constraints," three highs "personnel often face the temptation of a larger than normal people, social harm brought by the greater." 

 

In order to more deeply understand the causes of medical duty crime, including Xie Lianshen, team members, and guangzhou seven 3 armour hospital staff to carry on the meeting for many times, and designed a questionnaire, to see the doctor facing the confusion and the deep cause of corruption. 

 

Prosecutors found that under the high voltage unbalance is the doctor important reason of the crime. In to participate in the questionnaire survey of 487 doctors, nearly 65% of people think that should raise wage scale, to comply with the doctor's labor cost, think that the range of the increased wages shall be ranged from 30% to 100%. "For a long time, the doctor treatment and labor cost, etc., it makes a lot of doctors facing" kickbacks "can't refuse." 

 

In the prosecution of the case, the "three highs" involved doctors, were dissatisfied with their income level. Su Ming said, especially when some doctors found supplies agents is their classmates and get rich by "means" a few years, buying luxury cars, and himself as a doctor to heal the wounded and rescue the dying is only holding a dead wages bear big risk high labor intensity, mentality is imbalance. 

 

After being initiate an investigation, there are "three highs" personnel of their bribery allegations, "everyone else is accept, why don't we accept?" "The agent for the money, if I don't accept, is the agent himself, I defy spirit." 

 

Xie Lianshen and others, however, think that should be the behavior of doctors taking bribes and doctor of the medical product differently. "In handling cases, we found that the doctor is indeed very hard." Su Ming once because a case to go to the hospital for a doctor witnesses for questioning. The lunch time, the doctor refused to eat lunch, reason is "eat have surgery, in the afternoon will be sleepy". Based on this, at the time of interrogation of crime doctor, Su Ming and others will be addressed as "dear doctor" or "so-and-so, director of", rather than like a trial other suspects a first-name basis, even arrest when also try not to use the police car. 

 

Report suggested that doctors must be taken into account comprehensively by education, training time, labor time and intensity of labor, professional, technical content and other characteristics to establish salary system, risk compensation and the hospital, the doctor business income. At the same time raise the price of technical service, reduce the medical consumable materials fee, make the medicine for the medical "consumable materials for medical" into "technology for medical", make the hospital from the mode of the business model to return to the mode of the public welfare.