【英语中国】中国医疗行业的回扣文化

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所属分类:双语中国

2013-7-29 07:41

小艾摘要: In a hospital on the outskirts of Beijing, the hallway outside the main nurses’ station was unusually empty yesterday. “We usually have four or five representatives from the pharmaceutical companies ...
In a hospital on the outskirts of Beijing, the hallway outside the main nurses’ station was unusually empty yesterday. “We usually have four or five representatives from the pharmaceutical companies who hang around here, but today they’re all gone,” said one mid-level hospital executive. “They wait out there and try to invite doctors for meals and massages.”

These sales representatives, all of whom work for Chinese pharmaceutical companies, are just the most obvious manifestation of an endemic culture of bribery and kickbacks that pervades China’s health sector, according to doctors, investors and senior medical officials.

A widening Chinese investigation into bribery and corruption in the pharmaceutical industry has so far led to the detention of more than a dozen employees of GlaxoSmithKline in China, and is expected to affect other companies as well. Sir Andrew Witty, GSK chief executive, has warned investors of the potential impact of the investigation, which is focusing on deals totalling Rmb3bn ($488m). So far, no Chinese companies have been named in the industry-wide investigation, although the practice of bribing doctors, hospital administrators and health officials is rampant.

“All foreign and domestic pharmaceuticals operating in China are equally corrupt,” said one senior health official in Beijing, who asked not to be named. “There are many methods used to pay bribes but the majority of the money goes to the government to convince them to approve new drugs. Hospitals and doctors end up with a relatively small share of corruption proceeds.”

In 2007 the former director of China’s State Food and Drug Administration, Zheng Xiaoyu, was executed by lethal injection for taking bribes and dereliction of duty. Zheng was found guilty of approving unsafe medicines after taking about Rmb6.5m in bribes from pharmaceutical companies, resulting in some patient deaths.

During his eight years as head of the State FDA, Zheng ordered the approval of more than 150,000 medicines, an annual average of well over 100 times the number of medicines the US FDA usually approves.

In an interview with state television last week, Liang Hong, a GSK China vice-president who has been detained by police, said he mainly bribed officials through travel agents, who provided him cash and then charged the company for travel or meetings.

An executive from one of the travel agencies used by GSK said in the same interview that the amounts of cash could be as large as Rmb500,000.

The 2012 annual reports of half a dozen listed Chinese pharmaceutical companies reveal the companies paid out enormous sums in “sales expenses”, including travel costs and fees for sales meetings, marketing “business development” and “other expenses”.

The largest expenses were travel costs or meeting fees and in every case the expenses of the companies’ sales team were several times the net profits?each?company earned last year.

In the case of Guizhou Yibai Pharmaceutical, the company earned a net profit last year of Rmb333.3m while its sales expenses came to a total of Rmb1.25bn, including meetings expenses of more than Rmb295m and wages of just Rmb88m.

The largest expense for the company’s sales team of 2,318 people was Rmb404m spent on travel, for an average of more than Rmb174,000 per sales representative for the year. That is roughly what it would cost every single sales representative to fly 10 times a month between Beijing and Guiyang, where the company is based.

An executive at Guizhou Yibai said the travel costs were normal and included accommodation and food expenses. He also said the company had never paid any bribes through travel agencies.

Where corruption has afflicted the industry, it can cut both ways, according to the senior health executive in Beijing. “We’re talking corruption on top of corruption because pharmaceutical company representatives will give a Rmb5,000 bribe to a doctor or hospital but tell their company they gave a Rmb10,000 bribe and then keep the difference,” this executive said.

Other common methods used by sales reps to bribe officials, senior doctors or hospital administrators include opening bank accounts or charge accounts at luxury goods stores and handing the debit card or VIP card directly to the recipient.

Shaun Rein, a Shanghai-based consultant and author of “The End of Cheap China”, said he does not work at all in the healthcare sector because it is “too dirty”. “This is a systemic problem and foreign pharmaceutical companies are in a conundrum,” he said. “If they want to grow in China they have to give bribes. It’s not a choice because officials in health ministry, hospital administrators and doctors demand it.”

Mr Rein once considered investing in a Chinese hospital specialising in heart disease, but endemic corruption convinced him that the risks were too high. He said doctors at the hospital earned official salaries of less than $1,000 a month, but with kickbacks they pulled in $300,000 a year.

“The government has been trying to crack down on this practice for more than a decade,” Mr Rein said. “But nothing seems to change.”

One investor, who asked not to be named, added: “Whenever you touch a Chinese hospital there are underpaid doctors and companies that are willing to stuff the [sales] channel by paying backhanders.” His company decided not to take a small stake in a regional drug distributor?after realising that the business model “was clearly based on paying backhanders?in?the?range?of 15-20 per cent”.

昨日,北京郊区的一家医院,主护士工作站外面的门厅空空荡荡,不同寻常。这家医院的一位中层管理人员表示:“往常总有四五位药企销售代表在这里徘徊,但今天都走了。他们以往会等在那里,尝试邀请医生出去吃饭和做按摩。”

医生、投资者以及高级卫生官员表示,这些销售代表是中国医药企业的员工。贿赂与回扣的文化在中国医疗行业十分泛滥,而上述销售代表便是这种文化的典型特色。

中国对医药行业的贿赂腐败发起了日益深入的调查,迄今已拘留了葛兰素史克(GlaxoSmithKline)中国公司的数十名员工,预计还会波及其他药企。GSK首席执行官安德鲁?威蒂爵士(Sir Andrew Witty)警告投资者警惕调查的潜在冲击。这次针对葛兰素史克的调查重点是总额高达30亿元人民币(合4.88亿美元)的交易。目前为止,这场席卷整个行业的调查尚未提及任何中国企业,不过在中国,贿赂医生、医院管理人员以及卫生官员的行为十分猖獗。

北京的一位要求匿名的高级卫生官员表示:“所有在华经营的国内外药企的腐败程度不相上下。行贿手法五花八门,但大部分钱财都流进了政府手里,为的是说服政府批准新药品。而医院和医生只拿走了腐败收益中的很小一部分。”

2007年,中国国家食品药品监督管理局(SFDA)前局长郑筱萸因受贿与渎职被执行注射死刑。郑筱萸收受药企650万元人民币贿赂以后,批准了不安全的药品,导致部分病人死亡。

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在担任国家食品药品监督管理局局长期间,郑筱萸下令批准的药品超过15万种,平均每年批准的种类是美国食品和药物管理局(FDA)批准数量的100多倍。

被警方拘留的GSK中国企业运营总经理梁宏上周在接受中国中央电视台采访时表示,他主要通过旅行社贿赂官员,旅行社给他现金回扣,然后向GSK收取差旅费或会议费。

GSK聘用的一家旅行社的高管在同一采访中表示,现金回扣最高达50万元人民币。

6家中国上市药企2012年的年度报告中披露,企业支付了巨额“销售费用”,其中包括差旅费用和用于销售会议、“企业发展”营销以及“其他开支”的费用。

最大的开支是差旅费用或会议费用,每种情况下,企业销售团队的开支都是企业上年净利润的数倍。

以贵州益佰制药(Guizhou Yibai Pharmaceutical)为例,去年该公司的净利润是3.333亿元人民币,但销售开支总计达12.5亿元人民币,其中会议费用逾2.95亿元人民币,而工资支出仅为8800万元人民币。

这家公司2318人的销售团队支出最高的部分是差旅费,用了4.04亿元人民币,平均每名销售代表一年花掉17.4万元人民币。这大致相当于每名销售代表每个月在北京与企业总部所在地贵阳之间乘飞机往返10次的费用。

贵州益佰的一位高管表示,差旅费很正常,其中还包括住宿餐饮费。他还表示,公司从未通过旅行社行贿。

上述北京高级卫生官员表示,当腐败肆虐整个医药行业,药企自身也反受其害。这名高官表示:“我们讨论的是腐败之中的腐败。如果药企代表向医生或医院贿赂了5000元人民币,却会告诉自己公司贿赂了1万元,自己吃下差额。”

销售代表贿赂官员、资深医生或医院管理人员的其他常用手段,包括在奢侈品店开立银行账户或记账户头,然后直接把借记卡或者VIP卡送给收受人。

一位常驻上海的顾问、《廉价中国的终结》(The End of Cheap China)一书作者雷小山(Shaun Rein)表示,他绝不在医疗行业工作,因为这个行业“太肮脏了”。他指出:“这是一个系统性问题,外国药企进退两难。如果它们想要在中国发展,就必须行贿。这不是一个选择性问题,因为卫生部官员、医院管理人员以及医生都会索贿。”

雷小山曾考虑调查中国一家心脏疾专科医院,但无所不在的腐败让他认为,风险太大了。他表示,医院的医生每月工资还不到1000美元,但每年吃回扣的收入有30万美元。

雷小山表示:“10多年来,中国政府一直在尝试打击这种不当做法。但目前看来,似乎毫无成效。”

一名调查人员匿名补充道:“不管你接触中国的哪家医院,医生都薪酬微薄,而药企则愿意通过回扣来补充(销售)渠道。”他的公司决定放弃收购一家地方药品分销商的少量股份,因为他发现,该公司的商业模式“显然建立在15-20%的返点基础之上。”

译者/何黎

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