Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing 100191, China.
National School of Development, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China.
Health Policy Plan. 2023 Apr 11;38(4):496-508. doi: 10.1093/heapol/czad015.
Medical corruption is a significant obstacle to achieving health-related Sustainable Development Goals. However, the understanding of medical corruption is limited, especially in developing countries. As the largest developing country, China is also plagued by medical corruption. By employing a mixed-methods design and combining data from three resources, this study attempts to examine patterns of medical corruption in China, explore its key drivers and investigate the perceived effectiveness of recent anti-corruption interventions. Using extracted data from 3546 cases on the China Judgments Online website between 2013 and 2019, we found that bribery, embezzlement and insurance fraud accounted for 68.1%, 22.8% and 9.1% of all medical corruption cases, respectively. Bribery was the major form of medical corruption. Approximately 80% of bribe-takers were healthcare providers, and most bribe-givers were suppliers of pharmaceuticals, medical equipment and consumables. Using a nationally representative household survey, we further found that the prevalence of informal payments from patients remained at a low level between 2011 and 2018. In 2018, only 0.4% of outpatients and 1.4% of inpatients reported that they had ever given 'red envelopes' to physicians in the past. Finally, we conducted interviews with 17 key informants to explore drivers of medical corruption and investigated the perceived effectiveness of recent anti-corruption interventions in China. Interview results showed that financial pressure and weak oversight were two main reasons for corrupt behaviours. Interview results also suggested that the anti-corruption campaign since 2012, the national volume-based procurement, and the special campaign against medical insurance fraud had reduced opportunities for medical corruption, implying China's positive progress in combating medical corruption. These findings hold lessons for anti-corruption interventions in China as well as other developing countries.
医疗腐败是实现与健康相关的可持续发展目标的重大障碍。然而，人们对医疗腐败的理解有限，尤其是在发展中国家。作为最大的发展中国家，中国也深受医疗腐败之害。本研究采用混合方法设计，结合来自三个资源的数据，试图探讨中国医疗腐败的模式，探索其关键驱动因素，并调查最近反腐败干预措施的效果。利用 2013 年至 2019 年中国裁判文书网上 3546 个案例的提取数据，我们发现贿赂、贪污和保险欺诈分别占所有医疗腐败案件的 68.1%、22.8%和 9.1%。贿赂是医疗腐败的主要形式。约 80%的受贿者是医疗保健提供者，而大多数行贿者是药品、医疗器械和耗材的供应商。利用一项全国代表性的家庭调查，我们进一步发现，2011 年至 2018 年，患者的非正式支付率仍处于较低水平。2018 年，只有 0.4%的门诊患者和 1.4%的住院患者报告过去曾向医生送过“红包”。最后，我们对 17 名关键知情人进行了访谈，以探讨医疗腐败的驱动因素，并调查中国最近反腐败干预措施的效果。访谈结果表明，经济压力和监督不力是腐败行为的两个主要原因。访谈结果还表明，自 2012 年以来的反腐败运动、全国按病种付费采购和医疗保险欺诈专项整治活动减少了医疗腐败的机会，这意味着中国在打击医疗腐败方面取得了积极进展。这些发现为中国以及其他发展中国家的反腐败干预提供了借鉴。
