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Follow-up to “Red Package Health Care in China”

by Nick Jacobs

 This could have been a comment to Fred Fortin’s last blog post, but, since it’s so long, I decided to blog it.

This comment came from a wonderful, Chinese physician friend:  “I have practiced in a half dozen different hospitals in China and can tell you definitively that the Red Package is absolutely true in China.”  His very clear description of the life of a physician in China is that it is a very high risk profession.  The majority of hospitals have no malpractice insurance.  If the patient has a problem with the physician, there have been numerous cases where physicians are beaten, kidnapped and sometimes even killed.  Most of the time, he explained that hospitals choose to take no action, and the police usually assume the same position.

Physicians in China earn just a little more than the average salary.  The income does not match their education, requirements and talent, and according to my physician friend, respect for physicians is not very high.

Solutions?  Well, because it is a third world, developing country, there are numerous challenges.  A health insurance system for the people of China, support from the media, and, generally, protection for them provided by hospitals and law enforcement organizations would go a long way.

So, when the Red Package is discussed, it brings back memories of a conversation that I had with an accountant once said to me, “If you want to make an honest man dishonest, pay him too little and put him in a position where he is exposed to cash on a daily basis.”  Red Package is a way of life in most developing countries.

While speaking at a World Health Organization conference in Africa, I noted that what we would give as a tip after service in the United States is given as encouragement to receive that service in Aftrica.  Bribes by any other name may be considered TIPS, and, if it takes a TIP to save your mother-in-law, I’m sure you won’t think twice to do that!

Not too many years ago, in the United States, we had physicians taking vacation cruises paid for by pharmaceutical companies. These gifts were intended to encourage the use of their product.  Was this payola or advertising?  Bribes or Tips?  Red Packages are actual income enhancements for service to be rendered in a society that does not recognize the true value of the medical profession.  Ethical or unethical?  Yes, it is.