BEIJING, Sept. 2 -- As she slept in her grandmother's arms after coming off a drip in a Beijing hospital, Wenwen's mother was desperately praying her 1-year-old daughter did not need to be hospitalized again.

    Zheng, who declined to give her full name, had already been charged 100 yuan (14 U.S. dollars) for the drip to help treat her little girl's diarrhea and was anxiously awaiting the results of blood tests.

    Zheng and her husband had already borne the brunt of one batch of medical bills this year, after Wenwen contracted bronchitis in the spring and spent 11 days on the wards at No 1 Hospital of Peking University.

    The cost of her treatment totaled 7,800 yuan (1,142 U.S. dollars), almost her parents' combined monthly income, while only half was covered by their insurance policy.

    Zheng complained that doctors do not tell patients which treatments are covered by insurance and said she would prefer to buy medicine at the drug store, where the prices are cheaper. She is only stopped by the fear hospital staff would then not treat her daughter properly.

    "Wenwen was prescribed steam inhalation when she was ill in spring, but she recovered from her fever before she had the treatment. I still got charged full price," she said.

    Zheng's experience is just one of the many patients facing in a healthcare system that many experts agree is sick.

    Common accusations center on the fact that millions of citizens are denied basic treatment, with doctors and medicine scant in rural areas, and that drugs are over-priced, doctors take kickbacks from pharmaceutical companies and hospitals hold vulnerable patients to ransom.

    The State Council in July announced it was allocating 850 billion yuan (124 billion U.S. dollars) towards its healthcare reforms, which aim to have 90 percent of citizens covered by a universal system by next year, as well as include plans for 30,000 new hospitals, clinics and care centers.

    Starting next month, the central government will also heavily subsidize a list of common medicines.

    Public hospitals and doctors often rely on profits from the sale of drugs, as well as expensive treatments and tests, to cover their operating expenses.

    But experts have accused them of aggressively prescribing pricey and sometimes unnecessary medicine or treatments, which impacts both the patients' pockets and health resources.

    The new essential medicines list includes Western and traditional Chinese medicine to be sold at cost price. It features antibiotics, such as amoxicillin and streptomycin, painkillers like aspirin and paracetamol, and relief for coughs, colds, anxiety and high blood pressure.

    The Ministry of Health aims to equip about a third of the nation's public grassroots health facilities with every drug on the list by the end of the year and all State-owned medical institutions by 2020.

    Gordon Liu, head of health economics and management for the capital's Peking University, said the drugs on the list would treat 60 to 80 percent of the most common illnesses. But for the policy to effectively stamp out over-prescription, it must be accompanied by other initiatives to address how doctors and hospitals are paid for their services, he said.

    "This policy may help rationalize the use of medicine and reduce the cost of medicine to some extent, but it cannot solve the whole problem," said Liu. "Doctors may still have incentives to try to find ways to compensate the loss of their medical services due to government price regulations."

    Some doctors are increasing their incomes by receiving bribes, according to healthcare professionals who talked to China Daily on condition of anonymity.

    Many said the value of cash and gifts given to doctors by pharmaceutical sales representatives can even exceed 7,000 yuan a month.

    "Doctors do take commissions for certain brands of medicine," said a retired accountant surnamed Yang who worked with a pharmaceutical company based in Shaanxi province. "Medical representatives of pharmaceutical or trading companies also offer bribes to purchasing directors and presidents of hospitals on big purchases such as X-ray apparatus and bulk-order medicines.

    "Drugs are excessively priced. Back in the 1980s, price officials would visit the pharmaceutical factory to follow the entire manufacturing process, examining the costs and then deciding the price. Now, they rarely do that.

    "Some officials who are responsible for pricing take bribes from pharmaceutical companies. They simply read the documents prepared by the companies, on which costs are often exaggerated."

    Wang Zhen worked for seven years in pharmaceutical sales and earned millions before quitting to switch to the advertising industry.

    He said: "I earned enough to buy two apartments in Hangzhou (Zhejiang province) but in the end I was so fed up with sending gifts and bribing clients to promote my business."

    Another industry insider said his company had a budget of 3,000 yuan a month for cash payments or gifts of food, clothes, watches and beauty products to medical professionals, usually directors of hospital departments and high-level doctors or those with professional reputations.

    Although there is confidence within the healthcare industry the reforms will help curb medical corruption, as they will not be fully implemented until 2020, the moves are unlikely to solve the problem in the short term.

    Raising doctors' "unreasonable" salaries is also part of the reforms. However, no agreement has yet been made over the level of increase.

    "The reason doctors take bribes is because they receive an unreasonably low income that is not commensurate with the pressures and the risks they have to take on the job," said a senior orthopedic doctor from a large hospital in Wuhan, Hubei province, who asked to remain anonymous. "Our income is far lower than that in developed nations, such as the United States."

    Salaries for doctors range from 7,000 to 8,000 yuan a month, including bonuses of 4,000 to 5,000 yuan for the number of patients treated and treatments prescribed, said Liu Chunxiao, director of urology at the Zhujiang Hospital in Guangzhou, Guangdong province, who makes rounds from 8 a.m. and performs three to four operations a day.

    In cities such as Beijing, the situation is almost as bad. Liu Guang, a member of staff at the General Hospital of the People's Liberation Army, which offers medical services to high-level Party members and Central Military Commission members, said a director or deputy director of a department usually earns only 6,000 to 8,000 yuan a month in salary and bonuses.

    "The salary is not fair. Even if it's not the worst in Beijing, it does not match the risks and challenges doctors face every day," he said. Physicians in the US often command annual salaries of up to $200,000, the equivalent of almost 120,000 yuan a month, while doctors with the National Health Service in Britain can earn more than 90,000 pounds (145,000 U.S. dollars) a year.

    Poor pay for medics has been one of the major factors fueling corruption in hospitals and, when sales representatives offer them 5 to 10 percent of the price of a unit of medicine every time they write a prescription, doctors find it hard to resist.

    "Few doctors say no to the money," said the senior orthopedic doctor in Wuhan.

    Not everyone adheres to the common practice of bribery, however, according to a Beijing-based medical information communication specialist surnamed Su at U.S. company Pfizer.

    She insisted the firm never pays money to doctors to encourage them to prescribe their products and instead holds forums for medical professionals to promote its latest products.

    "We have the best products, so we're not worried about them not prescribing the Pfizer brand when patients are in need," she said. "What we are concerned about is whether doctors know how to use the products correctly. We consider ourselves information communication specialists, not sales representatives."

    She admitted the firm did send gifts to doctors but refused to elaborate, adding only that other international companies did the same and that it was "just a way of showing concern for doctors".

    Ji Shaoliang, a professor from Beijing University of Chinese Medicine, said the healthcare reform would clamp down on corrupt practices.

    "Under the reform, the Chinese government will be responsible for setting prices for the medicines in the latest National Basic Medicine Catalogue. Provincial governments will put out a tender to companies selling drugs and those that are successful will have to sell the medicine at the fixed price," he said.

    "In this way, there will be little motive for pharmaceutical companies or trading companies to send sales representatives to lobby doctors about what they prescribe."

    However, corrupt doctors will still be able to prescribe drugs not on the government-sanctioned list in order to take a commission, he said.

    To counter this, the authorities are working on a system that requires hospitals to annually bulk-buy medicines in the catalog to create expensive stockpiles they will be obliged to dispense, or face as yet unspecified sanctions.

    Better technology, which is perceived by many as a guardian against corruption, is also being rolled out across the country, with a proposed unified IT system to reduce healthcare costs and make them more transparent.

    "Every patient will have a log that records his or her illness, symptoms, prescriptions and drug doses. Therefore patients will be able to know whether they are being over-prescribed," explained Zhou Bin, managing director of the Perot System for Healthcare China.

    Meanwhile, officials at the Ministry of Health believe the new medicine policy will create competition among manufacturers, who will compete for the commercial advantage of getting their drugs on the preferred list, as well as lead to more mergers and acquisitions in the fragmented industry.

    "Essential drugs will be purchased through competitive bidding," said Zheng Hong, head of the ministry's medical policy and essential drugs program. "It's impossible for all makers of the same drug to win bids ... so the impact will be more mergers and acquisitions."

    However, if there are fewer companies bidding to supply basic drugs, what supervision will there be to ensure the quality of medicine will be maintained? Is it a good thing for a drug company to have a monopoly on the cheapest treatments?

    When put to Yu Mingde, director of the Chinese Pharmaceutical Enterprise Association, he declined to answer, insisting the system was OK.

    The State Food and Drug Administration will be responsible for supervising the bidding and the quality of drugs, but fears remain that since the pharmaceutical firms are said to have offered bribes to doctors and hospitals, they could also do the same to government officials.

    Only time will tell whether the healthcare system will be healed, but not everyone is convinced it will.

    (Source: China Daily)