Black Money Haunts the White Tower
United Daily News editorial (Taipei, Taiwan, ROC)
March 30, 2011
More procurement scandals have broken out in public hospitals. The Taoyuan District Court has taken four suspects into custody. They include Department of Health officials, the DOH Hospital Chief, and manufacturers. Others are out on bail and under house arrest. No one who knows anything about the medical community on Taiwan is surprised. Their reactions will be the same as former Director of Health Yang Chi-liang.
In the past, "black money," i.e., bribe money, was rampant in the larger public hospitals on Taiwan. This included implicit or explicit appeals to patients for "red envelopes," to drug manufacturers for kickbacks, to procurement personnel for commissions. It even included compulsory contributions for activities inside and outside the hospital. Fortunately, people are becoming more enlightened. Hospital management systems are gradually straightening out their act. The NHI payment system and joint procurement of drugs have made red envelopes and drug kickbacks increasingly rare. Every now and then however, prosecutors will uncover a hospital procurement scandal involving huge sums, that shock the medical community and society as a whole.
Times have changed. New medical devices swiftly become obsolete. The higher the procurement price, the more exorbitant the commissions. This presents a powerful temptation for anyone. Physicians often find themselves in control of large sums of procurement funds. Vendors lobby them day and night, assuring them they will never be found out. Such temptations are hard to resist. Therefore to those in the know, the procurement scandals that have surfaced so far are merely the tip of the iceberg.
in some large public hospitals, rumors of black money have never ended. Because both parties usually refuse to admit guilt, investigating such cases is not easy. But among some large medical equipment providers, the whispers have never stopped. One key factor is that within medical circles on Taiwan, doctors have long been king, Those in charge of large-scale procurements are usually docotrs. As a result, doctors are usually the ones caught during procurement scandals.
Over the past two years the Department of Health has increased restrictions on the outsourcing of medical operations. This may have improved the situation in some public hospitals, reducing procurement abuses. But it has not solved the problem completely. Will halting the outsourcing of medical operations prevent procurement scandals? No one would dare make such a guarantee. In fact, many hospitals benefit greatly from outsourcing. Medical expenses are reduced while income is increased. Many of these are public hospitals. But when the same measures are introduced in DOH hospitals, they paradoxically become a major source of scandals.
The cause of procurement scandals has nothing to do with outsourcing. It has everything to do with the procurement system itself. The public health care system has long opposed laymen being charged with procuring medical devices. But turning total control over to doctors unwittingly increased the opportunities for dirty money. That is why Chang Gung Memorial Hospital has long separated the requisitioners from the purchasers. The administrative staff forms a group responsible for procurement and bargaining. This makes it impossible for merchants to offer bribes. This model merits consideration.
For physicians to actively refuse bribes requires certain conditions. One way is to ensure that doctors are paid enough to keep them honest. But health insurance benefits continue to shrink. Public hospitals find it hard to make ends meet. Leave aside increases in staff salaries. Young doctors must economize on everything from food to clothing. They must work hard to succeed. When large sums of money pass through their hands, how many can resist? How many are not tempted to take something off the top?
Public hospitals want to reduce disputes over black money. They should consider the hospital's position. Public hospitals are subject to human limitations and to the procurement laws. They must be self-financing. They are non-profit public health providers. Clearly the pressure on them is too great. If public hospitals accept government subsidies, they can remain non-profit. They can avoid becoming profit-oriented. This will naturally reduce the phenomenon of black money. But this means government must underwrite their losses.
If the government is unwilling to underwite such losses, or cannot underwrite such losses, it may wish to transform them. They could be privately managed but publicly owned. Their operations could be cut back. Tainan Municipal Hospital has been privately manageed but publicly owned for 20 years. It remains one of Tainan's important medical institutions, and is very well known. There is no reason DOH hospitals could not change their operating model. Meanwhile, some Department of Health hospitals are located in resource-intensive areas. They have no particular raison d'etre. They long ago lost whatever signficance they had when they were founded. Why not phase them out, consolidate, or transform them? DOH hospitals must separate the wheat from the chaff. This will improve their overall quality.
The scandal has undermined the reputation of the medical community. The medical community must share in the shame. It must feel deep remorse. But hospitals continue to develop, and the temptation of money remains. To avoid deleterious results, they must stress medical ethics. They must also consider more fundamental factors. They must cure the disease at its root, and not merely suppress its symptoms. Only then can they eliminate this chronic illness.