RT Journal Article
SR Electronic
T1 Moving towards a better path? A mixed-method examination of China’s reforms to remedy medical corruption from pharmaceutical firms
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e018513
DO 10.1136/bmjopen-2017-018513
VO 8
IS 2
A1 Shi, Jianwei
A1 Liu, Rui
A1 Jiang, Hua
A1 Wang, Chunxu
A1 Xiao, Yue
A1 Liu, Nana
A1 Wang, Zhaoxin
A1 Shi, Leiyu
YR 2018
UL http://bmjopen.bmj.com/content/8/2/e018513.abstract
AB 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.