Medical kickback refers to the illegal behavior of medical personnel in medical institutions taking advantage of their prescription position to illegally accept the property of pharmaceutical product sellers such as drugs, medical devices and medical and health materials in various names, so as to seek benefits for pharmaceutical product sellers.

Since the 1990s, some pharmaceutical companies have found that drugs can be sold to hospitals by bribing the person in charge of the hospital, but if doctors don't use them, the sales of drugs are still very limited. As a result, a group of people specializing in doctor's work began to appear in the hospital, that is, medical representatives. In order to encourage doctors to use the products they sell more, every doctor who uses his own medicine has a commission. At first, the amount of money was very small, only one or two dollars. Although it is small, it works well. Compared with advertising, it costs less, but the effect is quite different. No matter what medicine, as long as there is a rebate, there is no reason why doctors can't use it. After the initial tinkering has not been effectively curbed, the rebate trend has intensified, from the initial 1% to the highest 30% or even 50% now. Medical kickback has become an important part of doctors' income in big hospitals, and it is generally in the trend of letting a hundred flowers blossom. Pharmaceutical companies must have clinical salesmen, that is, medical representatives now. If you don't do this, pharmaceutical companies can't survive at all. According to a data provided by the Leading Group for Combating Commercial Bribery of the Ministry of Health in 2005, in the national pharmaceutical industry, drug kickbacks embezzle about 772 million yuan of state assets every year as commercial bribery, accounting for about 16% of the annual tax revenue of the national pharmaceutical industry.

Hidden rules of medical kickbacks

Regarding the hidden rules of the operation of medical kickbacks, a medical representative said that there is a rule in the industry that "if you don't look for three types of doctors, you must know two types of doctors". Three kinds of doctors are: nurses, trainee doctors and senior doctors; We must know two kinds of doctors: clinicians in charge of beds and doctors in charge of wards. Most of their positions in hospitals are attending physicians, deputy chief physicians and chief physicians.

Medical representatives need to investigate the departments and names of the two doctors, and even their personal hobbies. You can't come to the door until all the preparations are completed. Get familiar with it in various ways, such as seeing a doctor, and then chat until you get familiar with it. Followed by eating, entertainment, travel, reimbursement of book fees. The so-called "book fee" is actually the "opening fee", ranging from several hundred yuan to thousands of yuan. After the "bottle opening fee" was delivered, the medical representative began to negotiate with the doctor about the specific rebate ratio. "We all call the word' kickback' too ugly, so we all call it' prescription fee' and' prescription fee'," a medical representative told China Newsweek.

After drugs enter the bidding catalogue and start to be used in hospitals, medical representatives will settle kickbacks with doctors on a regular basis. Doctors give their prescription records or patients' bed numbers and medication records to medical representatives. Then the medical representative went to the pharmacy department for examination-the pharmacy department has naturally been opened by the medical representative.

The "prescription fee" is just the usual fee that doctors get. At the end of each year, drug dealers try their best to entertain them. Some big drug dealers use various seminars and academic exchanges to travel and shop for free, and small drug dealers also need to reimburse doctors for some unidentified money in return.

A medical representative said that kickbacks have become an important source of income for many doctors, and the fundamental reason is that their normal income is too low. A doctor (usually a college graduate) only has more than 2000 yuan on his payroll, so it is difficult to resist the temptation of kickbacks.

open secret

Doctors can get kickbacks when prescribing drugs, which has become an "open secret" in recent years. Almost all the major hospitals in China have medical representatives. In order to promote their own medicines, they promised that every time a doctor prescribed a box of medicines, he would get a rebate according to a certain proportion of the price. As the insider of this industry is constantly exposed by the media, we know that medical kickbacks not only "fatten up" a group of doctors, let them live a life of driving famous cars and living in good houses, but also make medical representatives earn a lot of money themselves, with an average monthly income of about 10,000 yuan ... Recently, some medical representatives finally could not bear the condemnation of their conscience and stood up and expressed their remorse for this behavior that extremely harmed the interests of consumers. An Anhui doctor, driven by a sense of justice, constantly reported various kickbacks from hospitals, which aroused social concern. Our reporter recently listened to their stories.

Medical representatives set up "charity hall"

Zhao Zhongcheng used to be a medical representative, but now he is doing charity. He opened a "Charity Hall" pharmacy in Changsha, Hunan Province, and at the price of just breaking even, he sang against powerful hospitals, pharmaceutical companies and even former colleagues with a storefront of tens of square meters.

During the nine years from 1994 to 2003, Zhao Zhongcheng has been a medical representative. He told reporters that after the drug leaves the factory, it must go through the agents of national, provincial and local pharmaceutical companies before it can reach the hospital. In these intermediate links, in addition to the "money to be taken away" by agents at all levels, hospitals, from presidents, pharmacy directors, doctors to finance and pharmacies, must get corresponding "commissions" according to the size of their posts. In this way, the price of drugs was raised step by step. A drug with an ex-factory price of 30 yuan has become 100 yuan in the hands of patients; There is also a drug money from 65 yuan and 44 yuan, which is used to run around some hospitals. If the money is sent less or not in time, the hospital's "little shoes" will come at once. To "save the situation", we must redouble our "filial piety."

"Being a medical representative has improved my life, but it is also very hard." Zhao Zhongcheng said that before 1996, he made five or six hundred kinds of medicines. The hospital wants goods, even if it costs 30 to 50 yuan, it has to send dozens of miles. "The fare is not enough." On a "big day" like the Spring Festival, it will take him at least three days to decorate "all kinds of immortals". Once he was 30 years old and still running outside, he didn't even buy the dishes for the New Year's Eve dinner. In addition to physical hardship, human hardship is a headache for him. Zhao Zhongcheng described it this way: If you need anything at home, the leaders of the hospital will come to you in the middle of the night. They go to eat midnight snack, dance and sing, and then call directly: "Come and pay the bill". "As long as he has a little power, you have to bow and keep in touch. Even the porters dare not offend. " Zhao Zhongcheng said sighing.

Zhao Zhongcheng's conscience has not been erased by his long career as a medical representative. For some hospitals, he is more and more unbearable: a cancer hospital in Changsha earns 300 million yuan a year and spends 6 million yuan on advertising, but patients can't return boxes of medicines there. In the past nine years, he has seen too many patients being "eaten alive" by high drug prices in order to treat diseases. As soon as the money is used up, they are swept out of the house. All this makes Zhao Zhongcheng's conscience uneasy. Every time relatives and friends ask, he will persuade the other party not to go to the hospital to buy medicine and help him buy it himself. Finally, when my uncle spent all his savings to treat psoriasis and finally committed suicide by taking poison, he couldn't stand such torture any longer. He went home and thought for two months, and finally decided to use the accumulated experience as a medical representative and the money he got to open a charity pharmacy to help patients avoid the inflated drug prices.

The "Charity Hall" pharmacy officially opened on June 5438+ 10, 2004, mainly selling anticancer drugs, and the address was specially chosen opposite the above-mentioned cancer hospital. Because "among all patients, cancer patients are the most unfortunate. Just buying medicine can save a lot of money. " The reporter saw from the drug price table provided by Zhao Zhongcheng that the hospital sells oral liquid of 175 yuan, and the charity hall only sells 35 yuan; A capsule sold in the hospital costs 369 yuan, while the charity hall only sells 68 yuan ... dozens of medicines, and the price difference ranges from a dozen yuan to more than 200 yuan. Such a price difference is absolutely unheard of by reporters. How did they come from?

Zhao Zhongcheng told reporters that in fact, it is very simple, that is, all kinds of "intermediate links" mentioned above are omitted, so that drugs can directly reach patients from pharmaceutical factories. The experience accumulated by medical representatives for 9 years played a role at this time. When a pharmacy takes medicine or buys medicine for a patient, Zhao Zhongcheng will directly find the manufacturer, saying that he wants to be a pharmaceutical agent, and promises not to sell it to the pharmacy, and sell it to the patient immediately after getting it.

The low cost of "Charity Hall" attracts more and more patients, which naturally leads to the dissatisfaction of hospitals and peers. The opposite hospital often sends people to buy medicine, and when they get it back, they will check the authenticity, hoping to find "criminal evidence"; Hospitals often carry out negative publicity on patients, "demonizing" charity halls, saying that there are problems with drugs there; A medical representative came to rummage directly and was scolded back by Zhao Zhongcheng. Not long ago, some colleagues threatened them with trumped-up charges and forced them to raise prices. "This kind of thing happens every day." One way to crack down on the charity hall is to investigate and deal with it, and the other way is to out of stock. Zhao Zhongcheng overcame the latter through his "combat experience"; In the former, he can only be conscientious, so that there are no loopholes in quality, certification and management, and he does not give the other party an opportunity, and even promises to "fake one and lose one." Zhao Zhongcheng said that every year, the drug supervision department comes to the "Charity Hall" for random inspection 1-2 times, and they are qualified every time.

For more than two years, the charity hall has also been tested by patients. Zhao Zhongcheng told reporters that most patients are welcome, but a few don't understand and listen to some malicious propaganda and think they are liars. In this case, Zhao Zhongcheng said that he can place an order by computer, indicate the production batch number, and pay for it if it is false. But even so, some people don't believe it. "What else can I do?" Zhao Zhongcheng's tone is full of helplessness. However, in the interview, a patient came to buy anti-tumor drugs. The hospital sells this medicine for more than 440 yuan, and the charity hall only sells for more than 200 yuan. Zhao Zhongcheng taught him how to return the high-priced drugs in the hospital: "Just tell them to go to the media." The patient said that it was introduced by someone and felt that it was really affordable here. I didn't expect the medicine in the hospital to be so expensive at first. I hope there are more such pharmacies. "The support of these patients is enough." Zhao Zhongcheng told reporters that there are many repeat customers now, which makes him confident to make the "charity hall" bigger and "explore a new way to solve the problem of difficult and expensive medical treatment."

Anhui doctors reported kickbacks for 8 years.

Cutie is the chief physician of emergency medicine in the Affiliated Hospital of Anhui Medical University. Since 1998, he has embarked on a difficult but continuous reporting road because he can't stand the growing trend of accepting kickbacks from hospitals, and it has been eight years now. During these eight years, he reported his real name to the Anhui Provincial Health Department, the Supervision Department and even the Ministry of Health, and contributed to the People's Daily, reflecting that the Anyi Hospital was withdrawing the buckle. Some people call him a modern Don Quixote, because his report not only didn't stop doctors from taking kickbacks, but the hospital was also rated as a "model of spiritual civilization". However, he has been defeated repeatedly, challenging the "black hole" of the entire medical system.

Cutie told reporters that medical kickbacks had infiltrated Anyi as early as 1993. At that time, the hospital banned kickbacks and advocated learning from Bethune and carrying forward the spirit of dedication. So only a few doctors dare to take back the buckle. But by 1996, the situation of accepting kickbacks began to increase. "At that time, there were very few drugs with kickbacks, and the kickbacks were low, which was 5% of the drug price. The rebate for a box of medicine is 1 yuan. Doctors don't pay attention to which drugs have kickbacks and which don't. I didn't intend to take kickbacks when prescribing drugs. They were all sent by medical representatives on their own initiative, with a monthly fee of one or twenty yuan. " Zhang Shu didn't feel anything wrong at that time.

But gradually, he found that a few doctors began to prescribe drugs with kickbacks, and those that should not be used were used as medicines, and those that should not be tested were done. Some doctors can get a rebate of 1000 yuan a month. Many doctors are disgusted with a few doctors who prescribe drugs indiscriminately and get kickbacks, but some people envy imitators. During this period, Zhang Shu reported two doctors who were "interested in taking kickbacks" to the hospital and the provincial health department. This is his first time to report.

1998, the drug rebate has risen to 10%, the types of drugs with kickbacks have increased, and more and more doctors take kickbacks, with the highest price of 2,000 yuan per month. But at the same time, the phenomenon of disorderly prescription of drugs is rampant. Some doctors abuse drugs to patients, and often prescribe drugs that are not symptomatic, which not only wastes medical resources, but also may produce toxic and side effects, which will aggravate patients' condition. Zhang Shu is more and more aware that the hospital is changing from a public institution whose mission is to cure diseases and save people to a profit-seeking enterprise. That is, in this year, Zhang Shu, who inadvertently took a kickback of more than 300 yuan, officially withdrew from the ranks of kickbacks, and once again reported his real name to the Anhui Provincial Health Department and the Supervision Department. The tip-off letter was like a stone, but he was unwilling, and then he reported it to the Ministry of Health and contributed to the People's Daily.

199965438+1On October 23rd, People's Daily published a letter from Zhang Shu-"Why Drug Rebates are Repeatedly Prohibited". This paper lists in detail the phenomenon and examples of a doctor's kickback. This article caused great trouble to Zhang Shu: the hospital held several special meetings, which simply became a "condemnation meeting" for Zhang Shu, accusing him of "destroying the hospital". But at the same time, this article also attracted the attention of superior leaders. Subsequently, the leadership of the hospital changed, and the efforts to participate in the "National Top 100 Hospitals" were also lost. For more than a month after this article was published in the newspaper, medical representatives dared not come to the door, and the number of patients in the hospital dropped sharply ... but soon, due to the handling of this matter, everything returned to "normal".

1at the end of 999, Zhang Shu went to a research institute in Beijing for one year. While seeing the high personal quality and professionalism of doctors in Beijing, Zhang Shu was also surprised to find that "the phenomenon of kickbacks in many hospitals here is much worse than Anyi." Few people say "no" to the kickbacks of drug dealers and device manufacturers. A heart stent for treating coronary heart disease was sold for 300 dollars abroad and 20,000 yuan in Beijing, an increase of 8 times. Doctors can get a rebate of 2000 yuan for installing a stent for patients. During a lecture, a doctor said that 300 stents could be put in a year. As a result, everyone calculated that he could receive a rebate of 600 thousand, which brought him a sigh. What I saw and heard made Zhang Shu doubt his behavior: the whole country is the same. Is it fair to report only one doctor? He also fell into disappointment and confusion: these doctors are good people, why did they withdraw their buckles? Unconsciously, Zhang Shu set himself the "two noes": no medical kickbacks, no reporting.

This principle did not last long. In 2002, Anyi was rated as "Anhui Spiritual Civilization Demonstration Unit" by the province for the first time, and it was publicized to the public for comments. Zhang Shu was filled with indignation: "The phenomenon of a doctor withdrawing the buckle has not decreased, but has become more and more severe. How can it be called a model of spiritual civilization? " According to the published address, Zhang Shu reported his real name again. His report materials were approved and transferred to the provincial health department. In June 2002, the heads of two departments of the Health Department talked with him and asked him to produce evidence. Zhang Shu took out several computer bills signed by Dr. Qi Deru on the spot. It turns out that counting doctors' prescriptions is an important part in the drug rebate network. The hospital computer center counts the name and quantity of drugs used by each doctor and provides them to the drug dealers, who then calculate and give the rebate to the doctors. In order to deal with "unreliable" doctors like Zhang Shu, the hospital specially compiled a name "Qi Deru" and included all their prescriptions in this name. In this way, doctors who do not take kickbacks will not find themselves "earning" kickbacks, and no one knows where the kickbacks belong to "Qi Deru".

However, during the investigation, Anyi's computer charging system suddenly "paralyzed" and changed to manual charging. On the third day, the computer system was fine again, and "Qi Deru" no longer appeared. In the end, the hospital was rated as "Anhui Spiritual Civilization Demonstration Unit", and the phenomenon of collecting kickbacks did not stop. Looking at his repeated reports, Zhang Shu decided: instead of letting the "kickback" go unknown, it is better to use it in useful places. So, from April 2003, Zhang Shu also "received" the kickback. But every month, he sends his kickback to the "Spring Bud Office" of Anhui Women's Federation to help out-of-school girls. By 2006, it had reached more than 40,000 yuan.

The Ministry of Health wants to crack down on drug rebates again.

Yu Zeng, former director of the Department of Medical Administration of the Ministry of Health and a senior hospital management expert, expressed great admiration for Zhang Shu's eight-year struggle against drug kickbacks, and pointed out that the phenomenon of collecting kickbacks and red envelopes in the medical field has reached the point of "thousands of people accusing". For the formation of this phenomenon, he analyzed that on the one hand, the supervision of hospitals and doctors has not been in place for a long time, and the formation of the situation of "taking medicine to support doctors" has been artificially condoned; On the other hand, it is related to the imperfect rules and fierce competition in the pharmaceutical industry, which leads to chaos in the whole industry.

According to the reporter's understanding, starting from July this year, the Ministry of Health will carry out in-depth self-examination and self-correction in the national health system. The main content is to control kickbacks and commissions of pharmaceutical companies. Although Zhao Zhongcheng and Zhang Shu are weak, we firmly believe that more and more people will realize it and eventually promote the improvement of policies and systems, so that the phenomenon of medical kickbacks will disappear completely.