Not long ago, my friend’s mother underwent a heart bypass surgery at a hospital in Beijing. Before the operation, my friend gave the presiding doctor and anaesthetist “hongbaos” of RMB10,000 (about S$1,900) and RMB3,000 respectively.
“They just took it like it came naturally. They didn’t even pretend to reject it. They are clearly old hands at this,” my friend said angrily.
... it is an unwritten rule that many patients give hongbaos to doctors in China’s major hospitals, especially when it involves surgery.
When I asked why he gave the doctors the hongbaos, my friend said it was because he wanted to get a reputable doctor to be in charge, and also for some peace of mind. “Everyone else is doing it. If you don’t, you can’t get a good doctor, and even if you do, you worry they won’t do their best.”
The fact is, it is an unwritten rule that many patients give hongbaos to doctors in China’s major hospitals, especially when it involves surgery.
So, it looks like everyone is a willing party. But behind all of this, how much helplessness and anger is there from patients?
In recent years, China’s anti-corruption efforts have swept through the government ranks, with many allegedly corrupt officials removed from their posts. However, such efforts have largely bypassed social corruption; one key example is doctors accepting hongbaos.
Major hospitals in China carry notices that doctors are not allowed to accept hongbaos, complete with contact numbers to report such activity. However, few doctors are seen to be punished for accepting them, and even fewer face legal penalties, which makes it unclear whether it is even against the law for doctors to do so.
In May 2019, Dr Yang Xiangjun, chief physician and doctoral tutor of the cardiovascular department at the First Affiliated Hospital of Soochow University, was reported by his doctoral student for inserting stents for kickbacks of up to RMB10,000.
In July 2019, Yang was removed as a Chinese Communist Party (CCP) member, and subsequently arrested. His offences included multiple occasions of accepting hongbaos and vouchers from patients and their families, and getting benefits for a medical supplies agent in return for substantial kickbacks. But Yang did not go to jail because he accepted hongbaos, because under existing laws, that is just “against the rules”. The alleged corruption was because of the kickbacks he received in the medical supplies case.
Throughout 2019, several other cases of corruption have been uncovered in places such as Zhejiang, Jiangsu, Anhui, and Hunan, with party secretaries and heads of hospitals removed from their posts. For example, Zhou Mengtao, former CCP secretary at the First Affiliated Hospital of Wenzhou Medical University (WMU), and Lian Qingquan, former president of the Second Affiliated Hospital of WMU, were both investigated within the same week. While these heads got into trouble over issues such as medicines, purchasing of medical equipment, and calling for tenders, doctors in major hospitals continued accepting hong baos.
On 21 November 2019, China’s National Health Commission released a notification that it will be reviewing the work processes at major hospitals, particularly in the three areas of clean party involvement, industry practices, and operations management. But while some media read this as a prelude to a climax in the fight against corruption in the medical industry, some industry players feel that despite the necessity of the review, there is a long way to go in managing medical corruption.
There are two main categories of medical corruption: either the head of the hospital works with some doctors or medical suppliers to get kickbacks through purchasing and using supplier-recommended products; or doctors take hongbaos from patients for hospital stays, consultations, and surgeries. In both types of corruption, it is the patients who bear the cost.
The helplessness of patients opens the door for doctors to accept hongbaos, while the lack of clear legal punishments for such actions makes doctors even more brazen in doing so.
Between the two, it is harder to detect when doctors accept hongbaos, because the patients “give” them to the doctors. To many patients, doctors are doing them a big favour by allowing them to be admitted to hospital and “doing their best” during surgeries. So, while a hongbao might hurt the pocket, it is an accepted practice to buy services and peace of mind.
The helplessness of patients opens the door for doctors to accept monetary gifts, while the lack of clear legal punishments for such actions makes doctors even more brazen in doing so.
In any case, patients are already suffering. And for doctors to shamelessly accept significant amounts in hongbaos is sad for patients and a stain on doctors. Such behaviour borders on criminal use of power, and is a social pollutant.
Moral and ethical persuasion and disciplinary action have been shown to have little effect on doctors accepting monetary gifts. The law has to work as it was intended to.