《柳叶刀》：如何解决中国医生商业贿赂问题？

下面是《柳叶刀》在线发表的关于中国医疗界贿赂问题的文章，尝试译成中文。这一问题国外同仁都看不惯了。。。。。。

The Lancet, Early Online Publication, 21 March 2011
doi:10.1016/S0140-6736(11)60137-2 Cite or Link Using DOI

柳叶刀  在线发表   2011年3月21日

How to solve the crisis behind Bribe gate for Chinese doctors

如何解决中国医生的商业贿赂问题

Original TextZhiping Yang a, Daiming Fan a

Recently, China's Ministry of Health has continually declared 1 that it will intensify its crackdown on bribery in hospitals, after news of a corruption scandal involving dozens of doctors in east China broke. An online post 2 on Nov 15, 2010 alleged that dozens of doctors at several hospitals in Hangzhou, Zhejiang province, were taking bribes from a health-care company. The doctors were said to have taken cash, motor oil, shopping cards, and digital cameras from a local medical device company, duly buying the company’s products in return. The blogger, under the name of CCTV9090, said that he had learned of this situation from a memory stick that he happened to ?nd on a bus. Ten pictures were also published, in which the names of doctors and the kickbacks they allegedly took could be seen clearly.3 The public reacted angrily toward the doctors listed in the post, saying that they seriously undermined people’s con?dence in and image of medical professionals, although insiders said it was an institutional problem.

近来，在涉及中国东部几十名医生***丑闻的新闻曝光后，中国卫生部一再宣称将强化对发生在医院的贿赂的惩罚。2010年10月15日，晚上有人发帖称，浙江省杭州市几家医院的几十名医生接受一家保健公司的贿赂。医生们接受了一家当地医疗器械公司的现金、车用机油、公务卡和数码相机，及时购买公司的产品作为 回报。博主CCTV9090，他是偶然在一辆公交车上捡到了一个U盘知道了上述情况。同时公开了十张照片，医生的名字和收受的回扣清晰的显示在上面。公众对帖子中的医生感到愤怒，认为他们严重伤害了百姓的信任和医疗界的形象，尽管业内人士说这是体制问题。
In our opinion, there are critical crises in China’s health system behind a situation commonly called Bribe gate in this country. In China, it is common for pharmaceutical and medical equipment companies to pay kickbacks and bribes to doctors and hospital sta? to boost product sales.4 It has become a hidden rule in the medical industry that doctors receive kickbacks which comprise part of the cost of drugs from pharmaceutical companies. Companies involved include bribe fees in their drug pricing.5 Medical equipment makers have also been involved in similar schemes.6 If a number of doctors in China prescribed drugs for patients depending on the amount of kickbacks from pharmaceutical companies, and not of treatment guidelines and the individual situation, it would be hard to say that Chinese patients have received the best therapy with most e?ectiveness and least cost. One patient in Beijing saw doctors in four di? erent hospitals with the same medical complaint.7 He took back four kinds of prescriptions to an expert panel, who were masked to the names of hospitals and doctors, to make an evaluation. Astonishingly, in China’s capital city, only one prescription was appropriate for the patient—the other three doctors had prescribed super? uous or improper drugs. It is unknown whether this problem is prevalent throughout the country.

我们认为，在这个国家被称为贿赂门的背后存在着中国卫生系统严重危机。在中国，制药和医疗设备公司支付回扣和贿赂给医生和医疗机构来促销产品是常见的，医生收取回扣成了制药公司药品成本的一部分成了医疗界的潜规则。相关公司的药价包含了贿赂费用。医疗设备公司也以类似的方式牵涉其中。如果中国的部分医生依靠制药公司回扣的数额为患者开具药物而不是根据治疗指南和个体差异为基础，那就不能说中国患者以低廉的成本和效果得到了最好的治疗。在北京的一位患者在4家不同的医院看病，都有相同的医疗投诉。他带回了四种隐去了医院和医生名字的处方给专家组评估。令人惊讶的是，在中国首都，只有一种处方适合这名患者-其他三种处方开具了不合适或高档药品。不知道这种问题在整个国家是否普遍。
Chinese doctors’ salaries are indeed small when compared with the high incomes that are paid in some monopoly industries in China with lesser technical skills than medicine, such as banking and transportation.8,9 Many physicians and surgeons consider kickbacks and bribes from drug companies as compensation for their high training costs and high professional risks.10 Doctors who are busy prescribing medicine to get kickbacks would e?ectively become the “employees” of downstream companies in the medical industry. Such doctors do not devote themselves to the advancement of medical knowledge or techniques, or to the improvement of health-service quality. This issue is one reason why there is little or no clinical evidence from China in many international guidelines. Few voices are heard from Chinese doctors in various world congresses when treatment guidelines are drawn up. We assume that this awkward situation will continue for a long time.

与医学相比对技术要求较低的中国一些垄断企业的高收入相比，中国医生的薪水确实很低，如银行业和交通行业。许多内科、外科医生将从医药公司得到的回扣和贿赂当做他们高昂的培训费和专业风险的补偿。忙于为得到回扣而开具处方的医生最终变成医药企业下游公司的雇员。这样的医生不会致力于提高他们的医疗技术，或致力于改善医疗服务质量。这一问题也是为什么在许多国际指南中很少或没有来自中国的临床证据的原因之一。在各种国际会议上当指南的草拟时，很少听到来自中国医生的声音。我们假设这种令人尴尬的状况将长期存在下去。
Bribegate is just the tip of an iceberg,11 although the government will take steps to improve the situation by stricter regulation and punishment, including suspension or revocation of medical licences in serious cases.1,3 Bribery in hospitals has increased in some areas of China, according to a news report about the Ministry of Health.12 We are much more concerned over the quality of the health care that patients have received and the improvement of clinical practice behind Bribegate in China. Chinese medical associations should develop rational drug-use guidelines to standardise doctors’
贿赂门只是冰山一角，尽管政府将通过更加严格的管理和处罚来采取步骤改善这种现状，包括在严重的情况下暂停或吊销医疗执业证书。根据关于卫生部的一条新闻报告，在中国的一些地区，医院贿赂的情况在增多。在中国贿赂门的背后，我们非常关注患者得到的医疗服务的质量和医疗技术的进步。中华医学会应该制定合理用药指南来规范医生的行为。

这篇论文很一般呢，没有从本质上讨论中国医生的问题，不过要深入讨论就要上升到政治的层面了。。。。。。看来，我也可以写一篇SCI批判中国的国情了。

唉~，一声叹息。
看起来很容易解决，但实则困难重重

可怜的中国患者！

温总理应该把对房屋开发商说的话再推广以下，医生们不要忘了，自己的身上也留着道德的血液。

悲剧的中国人！

在下看来，要解决看病难看病贵、医疗回扣的问题，从医生那里开刀是没有用的，杀了一个“我”，还有千千万万个“我”。拿医药公司开刀才行........最黑的是医药公司！！！

医药公司也会说“怨啊”，我没拿多少啊。源头是药品的定价机制，和流通环节太多！

同意8楼.直接出厂价基础上加价作零售价.国家也没必要搞什么第几十几次降价文件了.(大多比实际零售价还高?)

在钱面前，道德毫无意义。讲道德等于不讲。

只要ZF痛下决心，不管是房产商还是医生，管你流的什么血都得老老实实。

问题是ZF下得了决心割自己的肉么。