Informal Payments and Regulations in China's Healthcare System: Red Packets and Institutional Reform PDF
Preview Informal Payments and Regulations in China's Healthcare System: Red Packets and Institutional Reform
Informal Payments and Regulations in China's Healthcare System Red Packets and Institutional Reform Jingqing Yang ’ Informal Payments and Regulations in China s Healthcare System JingqingYang Informal Payments and ’ Regulations in China s Healthcare System Red Packets and Institutional Reform JingqingYang SchoolofInternationalStudies UniversityofTechnologySydney Sydney,NSW Australia ISBN978-981-10-2109-1 ISBN978-981-10-2110-7 (eBook) DOI10.1007/978-981-10-2110-7 LibraryofCongressControlNumber:2016956911 ©TheEditor(s)(ifapplicable)andTheAuthor(s)2017 Thisbookwasadvertisedwithacopyrightholderinthenameofthepublisherinerror,whereas theauthorholdsthecopyright. Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher, whetherthewholeorpartofthematerialisconcerned,specificallytherightsoftranslation, reprinting,reuseofillustrations,recitation,broadcasting,reproductiononmicrofilmsorinany otherphysicalway,andtransmissionorinformationstorageandretrieval,electronicadaptation, computersoftware,orbysimilarordissimilarmethodologynowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthis publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesare exemptfromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationin thisbookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublisher northeauthorsortheeditorsgiveawarranty,expressorimplied,withrespecttothematerial containedhereinorforanyerrorsoromissionsthatmayhavebeenmade. Coverillustration:CoverdesignbySamanthaJohnson Printedonacid-freepaper ThisPalgraveMacmillanimprintispublishedbySpringerNature TheregisteredcompanyisSpringerNatureSingaporePteLtd. The registered company address is: 152 Beach Road, #22-06/08 Gateway East, Singapore 189721,Singapore ToSuzhen,BochanandBozhi C ONTENTS 1 Introduction 1 2 SocialistMedicineandTheoriesofInformalPayments 29 3 InstitutionalChangesandthePowerofChineseMedical Professionals 67 4 HealthReformandtheRiseofInformalPayments After1978 133 5 TransactionsofRedPacketsintheHospital 187 6 ReininRedPackets 239 7 Conclusion 275 Index 281 vii L F IST OF IGURES Fig.5.1 Paymentandresponsibilitystructureinbureaucraticmedicine 233 Fig.5.2 Paymentandresponsibilitystructureinaredpackettransaction 233 ix L T IST OF ABLES Table3.1 Numberofprofessionalstaffofthewholecountry 107 Table3.2 Numberofhealthorganizationsandbedsofthewholecountry 107 Table3.3 Healthcareoperationalbudgetinthepre-reformera 108 Table3.4 Healthcarecapitalconstructioninvestmentinthepre-reformera 108 xi CHAPTER 1 Introduction IfthereformofanysectorthathaseverbeenclaimedafailurebyaChinese central government agency, it was the healthcare sector. In 2005, Ge Yanfeng,DeputyHeadoftheResearchDepartmentofSocialDevelopment oftheDevelopmentResearchCenteroftheStateCouncil,announcedthat “the healthcare reform was basically unsuccessful” (Wang 2005b). His announcement was first published in Chinese Youth, a leading national newspaper controlled by the Chinese Youth League Central Committee. Lateron,hepublishedajointlyauthoredbookelaboratingtheproblemshis teamdetectedinthehealthreform.Inthebook,heandhisteamblamedthe failure on excessive marketization, which led to increasing inequality, low efficiency, and proliferation of “unhealthy practices” in the healthcare sys- tem(GeandGong2007). The Ministry of Health (MOH) disagreed (Guo 2005). Gao Qiang, Minister of Health, when addressing a training workshop for provincial and municipal health department heads in November 2005, asserted that it was pointless to argue whether the health reform was successful or unsuccessful.1 His speech was widely interpreted as a formal denial of the failureandprovokedpublicoutcries.CommentatorsaccusedtheMOHfor being arrogant and disconnected with reality, and disrespecting public opinions(Liu2005). Even though the MOH did not agree with Ge Yanfeng on that it was wrong to choose marketization as the policy direction for health reform, senior health officials, including Gao Qiang himself, admitted that the Chinese healthcare system was fraught with problems resulted from the ©TheAuthor(s)2017 1 J.Yang,InformalPaymentsandRegulationsinChina'sHealthcareSystem, DOI10.1007/978-981-10-2110-7_1 2 J.YANG healthcarereform.2Amongtheseproblems,amajorconcernoftheMinis- try,thecentralgovernment,andthegeneralpublic,were“unhealthyprac- tices” that prevail within healthcare organizations and among individual healthcare professionals. Gao Qiang, in the Work Report addressed to the 2004 National Health Work Conference, admitted that the unhealthy practicesare“jeopardizingthevestedinterestofthepeople, damagingthe good image of the healthcare undertakings, impinging the flesh-blood relationship between the [Chinese Communist] Party (CCP) and the mass, and impeding health reform and development” (Gao 2004b). This remark manifested the CCP’s concern that unhealthy practices in the healthcare system could jeopardize its legitimacy of ruling. The unhealthy practicesthatGaoQiangmentionedinhisreportincludeddrugkickbacks, prescriptionforcommission,overcharge,over-provision,and“redpackets.” The first four unhealthy practicesinvolve illegitimate transactions between individual doctors and organizations, be it hospitals or third-party organi- zationssuchaspharmaceuticalcompanies.Althoughinappropriateincomes that doctors make from these activities ultimately come out of patients’ pockets,doctorsdonottakemoneydirectlyfrompatients.Usually,patients payformallytoorganizations,which redistributethe paymentsformallyor semi-formallyorinformallytodoctors. This book focuses on the fifth practice—red packet, which is different from the other four by nature. It represents doctors taking payments directly, unofficially, and illegally from patients. If the other four practices are organization-based misconducts, the red packet is an individual- centered misconduct that not only is endemic in China, but also wreaks havoconhealthcaresystemsworldwide. INFORMAL PAYMENTS AROUND THE WORLD Internationally,redpacketisusuallycalled“informalpayment,”butitisalso known by other names, such as “under-the-table payment,” “envelope payment,” “illegal payment,” “unofficial payment,” and soon. In general, the practice is mostly found in former and current socialist countries. Evidence indicates that informal payments already existed in the former SovietUnion(FSU)andtheSovietblocintheCentralandEasternEurope (CEE) and Central Asia (CA) before these countries commenced demo- cratic and market transition in the early 1990s (Miller et al. 2000). The collapse of socialism and the abandonment of the “Semashko” healthcare
The list of books you might like
