Is there a "hidden rule" for medical equipment procurement rebate? Yuexiu District Procuratorate investigates the causes of duty crimes of medical consumables.
Medical interventional equipment rebate 15%~20%, each medical film rebate 1.5 yuan … … Recently, Guangdong investigated and dealt with many cases of illegal profits from medical equipment and consumables. It is understood that with the implementation of zero price difference of drugs, the interest chain of medical corruption has been reconstructed, and some hospitals and doctors have changed their methods to gain benefits from medical consumables in the name of "regulations", and the means are more subtle. This kind of corruption cases usually involve medical personnel with high administrative level, academic qualifications and professional influence. Why are these famous medical experts with superb medical skills and saving lives lost in the temptation of interests? Recently, Yuexiu District Procuratorate visited seven 3A hospitals in Guangzhou within two months, sent out 500 questionnaires and wrote a 25,000-word investigation report. The report looks into a series of deep-seated problems of duty crimes of medical consumables.
case
Director of Cardiovascular Department takes bribes and falls off the horse.
Deputy director’s "succession" withdrawal buckle
Li Moumou is the director of the Department of Cardiology, a hospital affiliated to a university in Guangdong. He has been a doctor for more than 20 years, undertaken or participated in more than 10 national, provincial, ministerial and bureau-level topics, and published more than 30 academic papers, which has made great achievements in academic circles. He is also the first person to commit a case of consumables corruption in the field of cardiology in Guangzhou medical system. As a leader of the discipline, Li Moumou is a member of the bid evaluation committee. According to the confession, he accepted a bribe of 230,000 yuan from consumables suppliers to help them win the bid successfully.
At the end of 2014, Li Moumou was investigated for taking bribes, replacing Zhang Moumou, deputy director of the Department of Cardiology, who presided over the overall work of the hospital, and taking over the "work" of collecting kickbacks. Within two years, he received kickbacks from suppliers with three general doctors in the same department for more than one million yuan until he was arrested in 2016.
According to the prosecutor who handled the case, considering the interests of society and patients, Li was released on bail pending trial while waiting for the court’s decision, working normally in the hospital, and did not disclose the case in violation of regulations. Zhang Moumou, the deputy director, met with other doctors and thought that he was out of legal punishment and there was little risk of accepting kickbacks.
Neurosurgical leaders get kickbacks.
20% of the supplier’s claims are regulations.
What is the so-called "rules" for kickbacks? A case in Shenzhen Nanshan District Court last year revealed this hidden rule. The verdict shows that from 2010 to 2013, the defendant Zhai was the director of neurosurgery in a district people’s hospital in Shenzhen, and had the right to decide the use of medical consumables in the department. Zhai decided to use EV3 medical intervention products sold by a company in Shenzhen, and received a benefit fee of 480,000 yuan from Feng, the manager of the company, four times. Zhai said that he did not bargain with the supplier, and the bribe was given to him by Feng.
Feng said: "Zhai has always been a leader in neurosurgery, and neurosurgery surgery requires him to operate personally. Although our company’s products can enter the hospital as spare equipment through bidding, the decision on whether to use them is in Zhai’s hands. I can’t do this business without giving benefits. In our industry, the proportion of medical intervention products is basically provided at 15% to 20% of the product price, which is the industry rule. "
On May 3 last year, Zhai was sentenced to one year and seven months in prison for accepting bribes and fined 100,000 yuan.
status
The high level of personnel involved in the equipment field has a great impact.
Among the medical duty crimes handled by Yuexiu District Procuratorate, before 2010, they mainly occurred in the purchase and sale of drugs. Since 2013, cases of medical consumables have obviously started to occur frequently. Last year, all the cases of duty crimes in the medical and health field handled by the hospital occurred in the medical consumables. The reconstruction of the interest chain behind medical corruption represented by this trend deserves attention.
In addition, in recent years, people involved in medical corruption have shown the characteristics of high administrative level, high academic qualifications and high professional influence. Before 2013, medical corruption cases were mainly concentrated in inspection, logistics and infrastructure departments, whose staff had relatively low academic qualifications and professional requirements. With the gradual elimination of corruption in these peripheral areas, in recent years, industry leaders, medical personnel with director level and doctoral degree have been involved in the case for the vast majority. These people involved in the case have high professional influence in their fields, engage in administrative management, medical care, education and scientific research at the same time, have huge social resources, are less restricted, face greater temptation than ordinary people, and become high-risk groups of corruption in the absence of sufficient restriction mechanism.
Explore the cause
Professional use of consumables, less supervision, low cost of bribery crime by agents
How did the "rules" of consumables rebate come from? According to the analysis of the investigation report of Yuexiu District Procuratorate, hospitals, like patients, are also victims of the inflated price of medical consumables, opaque ex-factory price and multi-layer agent sales model. Take the heart stent as an example. The cost of a stent is several thousand yuan, but it is as high as 30,000 to 40,000 yuan when it is sold to patients. Some employees find that even if they don’t take kickbacks from agents, the price of medical consumables will not be reduced, and all the profits in the middle will be monopolized by agents.
The research report also pointed out that the procurement and management system of medical consumables did not effectively supervise the above phenomenon. Different from the centralized drug procurement in 2007, the online price limit and competitive bidding methods are implemented, and the procurement of medical consumables in Guangdong Province is still subject to separate bidding by medical institutions. In the procurement process of medical consumables in various hospitals, there is a large space for corruption due to insufficient external supervision and internal formal management. In addition, medical consumables are of great value, the cost is hidden, the use of consumables is very professional, and specialists have the right to speak on the use of consumables, so it is difficult for the regulatory authorities to intervene, which increases the risk of duty crimes in this link.
In addition, Yuexiu District Procuratorate sent 500 questionnaires to seven hospitals, and 50.8% doctors thought that the salary was 50% or more higher than the current income to meet their own labor pay and income expectations. The mismatch between salary and labor payment is one of the reasons for the frequent occurrence of duty crimes.
When a doctor involved in the case analyzed his motive to the prosecutor, he thought that the current doctor’s salary was too low, even with the briber — — There is also a gap between medical consumables agents. Some doctors involved in the case found that the agents were their classmates, and they took high-intensity and high-risk labor with dead wages, but they made a fortune through "buying and selling". For a long time, salary is not proportional to pay, which leads to psychological imbalance.
Since 2010, Yuexiu District Procuratorate has investigated 58 cases of medical duty crimes with 58 people. Of the 15 cases of bribery that have been decided, 9 cases with 9 people were not prosecuted, 5 cases with 5 people were sentenced to probation, and only 1 case with 1 person was sentenced to substantive punishment. Generally speaking, the treatment of bribers in the case is relatively light, and the low cost of illegal crimes has become an important reason for agents to constantly pay bribes and seek interest space.
Some bribery suspects said that they were worried that if medical staff were not given benefits, the products they represented would be difficult to be adopted, and even if they were adopted, they would easily be rated as poor products, thus being kicked out of the market. In order to maintain their business, they had to take "extreme measure" such as wooing medical staff with heavy money.
suggestion
Strengthening doctors’ occupational security and reducing abnormal profits of medical consumables
In view of the complex causes of duty crimes of medical consumables, the investigation report has issued a "prescription" of 8,500 words, calling for strengthening the professional security of doctors and establishing a salary system that reflects the value of doctors; At the same time, scientifically construct the price mechanism of medical consumables, reduce abnormal profits, and strengthen the supervision of the procurement and use process.
The report suggests that the salary system should be established by comprehensively considering the characteristics of doctors’ education time, training time, labor time, labor intensity, occupational risks and technical content, so as to decouple the salary from the business income of hospitals and doctors. By substantially increasing the annual salary of doctors, the survival and work pressure of young doctors at the grassroots level can be alleviated, and it is not necessary to obtain gray income through informal channels. At the same time, the price of technical services will be raised, and the charges of medical consumables will be reduced, so that the "medicine-based medical care" and "consumables-based medical care" will be changed to "technology-based medical care", and the hospital will return to the public welfare operation mode from the commercial operation mode, so that doctors can concentrate on seeing a doctor, improve the diagnosis and treatment level and serve more patients wholeheartedly.
In terms of consumables, the report suggests reducing intermediary links, making public the price information of medical consumables, strengthening the supervision of sales prices, reducing the abnormal profits of medical consumables and returning the prices to a reasonable standard. At the same time, we will carry out online procurement and unified procurement, and continue the monitoring to the use stage of consumables.
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