Shanghai Street View: Cleaning Slippery Scalpels 沪经动向：清理医疗腐败

Shanghai is known for its ability to tackle tough financial issues, and so I initially wasn’t surprised to read a recent report on its apparent success at fighting corruption in hospitals. This problem is one that few foreigners ever experience and many may be completely unaware of, even as the newspapers with reports of corrupt government officials who accept cash-filled red envelopes and other lavish gifts for greasing the wheels of China’s huge bureaucracy. It turns out the issue at hospitals in Shanghai and around China is similar, only it’s scalpels that are being greased and people’s lives that are at stake if their doctors don’t have sufficient “incentive” to do a good job.

Before I continue with my story, I should admit that I have little or no experience with the Chinese health care system, which is undergoing huge changes as Beijing rolls out a massive new network of free and subsidized care. That multibillion-dollar system is supposed to replace the former socialist system where everyone got their care for nominal fees or for free through hospitals that were part of their state-run work units.

I seldom visit any hospitals in China, mostly because the waits are long and it seems like anyone who goes in ultimately gets put onto an intravenous drip for treatment. But for the average Chinese, hospital visits are an unavoidable fact of life, since there are few other places to see a doctor and Shanghai’s handful of expensive private clinics are hardly an option.

The report that caught my attention was a small newspaper item on how Shanghai’s doctors and other medical professionals had returned more than 15 million yuan given to them in red envelopes, known locally as hong bao, over the last 3 years. The report didn’t go into much detail, except to say the returned money was the result of a citywide education campaign that combined technology and a focus on medical ethics.

I’d heard about the problem before when one of my friends complained about it, so I did an informal survey of some other friends and acquaintances and learned just how rampant the issue is and how inconsequential the figure in the report was. It became clear that the 15 million in returned money was tiny compared with the gift money that remained in doctors’ pockets. What’s more, it also became clear that, perhaps not surprisingly, Shanghai’s doctors were more distinguished from their peers in smaller cities by the much larger amounts of money they received in their envelopes.

One of my Shanghai friends remarked that the trend dates back to the 1990s, when many older hospitals that were part of big state-run enterprises were shut down and replaced by a new generation of more commercial entities that had to survive by charging fees. I was quite surprised when he remarked that one well-known Shanghai obstetrician, who was a friend of a friend, boasted that she could get as much as 40,000 yuan for a single operation, and that the same woman earned hundreds of thousands of extra income each year through such red envelopes.

Ironically, I doubt if any doctors or other medical workers have ever been prosecuted or even vilified in the media for accepting such huge amounts of money, even as stories of similar corruption among public officials have become common. Another Shanghai friend remarked there’s even a rough scale for how much to give, with small operations requiring a relatively modest several hundred yuan each, while a major procedures require several thousand. He said his own family gave its doctor a 4,000 yuan envelope when his father had a major surgery several years ago, as such payments not only assure better care but also can significantly reduce the waiting time for such procedures.

Having babies is apparently one of the most lucrative areas for doctors, requiring several thousand yuan in red envelopes per child. This no doubt plays on the worries of expectant parents who are only allowed a single child and thus want that child to be as healthy as possible.

Against those kinds of figures, the 15 million in returned red envelopes for Shanghai over 3 years — or less than $1 million each year for this city of 23 million — looks like a drop in the bucket. Clearly the city needs to turn up its “moral education” program and introduce other means to bring this major metropolis and others like it more into line with international norms. Otherwise, all the medical reform in the world won’t cure China’s ailing healthcare system.