The Fundamental Causes of Medical Corruption Issues from a Marxist Perspective

Overview#

Recently, the authorities' crackdown on medical corruption has sparked widespread attention, implementing a series of measures to investigate a number of significant cases involving hospital leaders, pharmaceutical company owners, medical software developers, and others.

On July 28, the Central Commission for Discipline Inspection and the National Supervisory Commission held a mobilization meeting to deploy disciplinary inspection and supervisory agencies to cooperate in the nationwide concentrated rectification of corruption issues in the pharmaceutical field. The meeting pointed out that a comprehensive and systematic governance of the entire pharmaceutical industry should be carried out. Efforts should be intensified in discipline enforcement and law enforcement, focusing on leading cadres and key personnel, insisting on investigating both bribery and corruption together, and concentrating efforts to investigate a number of corruption cases in the pharmaceutical field to create a strong deterrent effect.

Prior to this, in late July, the National Health Commission, in conjunction with the Ministry of Education, the Ministry of Public Security, the National Audit Office, the State-owned Assets Supervision and Administration Commission, the State Administration for Market Regulation, the National Medical Insurance Administration, the National Administration of Traditional Chinese Medicine, the National Center for Disease Control and Prevention, and the National Medical Products Administration, jointly held a video conference to deploy a year-long nationwide concentrated rectification of corruption issues in the pharmaceutical field. The meeting required a focus on key links and "key minorities" in the production, supply, sales, use, and reimbursement of the pharmaceutical field, adhering to both curative and preventive measures.

Under the sustained high-pressure crackdown, a number of hospital "top leaders" and key personnel have been successively investigated. According to incomplete statistics, as of now, at least 159 hospital presidents and secretaries have been investigated nationwide. Some of the cases are as follows:

At the end of July, the chairman of the antivenom serum pharmaceutical company, Sairun Bio, was placed under control and investigated.
In early July, Zhou Wei, the chairman of the medical software development company Weining Health, was placed under investigation and control for suspected bribery.
On August 7, the Central Commission for Discipline Inspection exposed the bribery case involving Yang Wenjun, the former president of Pu'er People's Hospital, and Yang Wenhong, the former vice president. The two were close friends with suppliers, and even when other members of the hospital leadership team clearly opposed, Yang Wenjun insisted on purchasing a linear accelerator and received a kickback of 16 million yuan.
On August 9, the Henan Provincial Commission for Discipline Inspection and Supervision reported the case of Wang Jianjun, the former party secretary and president of the Second People's Hospital of Henan Province, for serious disciplinary violations and illegal activities. Wang Jianjun used his position to seek benefits for others in the procurement of medical devices, construction projects, and received huge amounts of money.

This series of measures indicates that the authorities are strongly combating medical corruption with clear objectives. However, analyzing the fundamental causes of medical corruption from a Marxist perspective reveals several key factors.

We know that medical corruption is a product of the capitalist system, reflecting the conflicts and contradictions of interests between the pharmaceutical industry, the medical profession, and the state, as well as the deprivation and harm of the health rights of the oppressed classes. To solve the problem of medical corruption, a fundamental transformation of the medical industry under capitalism is necessary, allowing medical services to truly become a benefit for the people.

First, we must acknowledge that the pharmaceutical industry is a critical problem area within the medical field. "The capitalist mode of production is not centered on the relationship between producers and consumers, but is based on the interaction between capital owners and direct producers." In this environment, the pharmaceutical industry may promote its products and obtain high profits through means such as manipulating clinical trials, misleading medical knowledge, bribing or influencing doctors, researchers, and regulatory agencies. Such behavior severely infringes on citizens' rights to life and property, and poses a serious threat to social fairness and justice.

Second, the medical profession bears responsibility in medical corruption. "Bourgeois intellectuals constitute a special social class, economically dependent on the bourgeoisie while politically and ideologically influenced by bourgeois ideology." Some professionals in this field, as bourgeois intellectuals, naturally acquire power, status, and income through collusion with the pharmaceutical industry and the bourgeois government under the influence of bourgeois ideology. Additionally, as the dominant force in healthcare, the medical profession often excludes or suppresses other forms of medical services and imposes its standards and values on patients. This behavior causes the medical profession to deviate from the medical needs of the people and becomes an accomplice in exploiting the broad working masses under the capitalist system.

Furthermore, the state also plays an important role in medical corruption. The state often regulates and recognizes the activities of the pharmaceutical industry and the medical profession, usually in exchange for political or economic benefits. The state enforces laws and policies that maintain the interests of the ruling class, such as intellectual property rights, trade agreements, and medical insurance plans, while neglecting or harming the health needs of the broad working people. This bias leads to the unfair distribution of medical resources and social class inequality.

Finally, the oppressed classes are the biggest victims of medical corruption. Workers, farmers, and other socially disadvantaged groups, as well as others marginalized or discriminated against in the capitalist system, suffer from deteriorating health conditions, inability to access quality and affordable medical services, exposure to harmful or ineffective drugs, and exploitation by the medical system. The plight of these oppressed classes is a direct consequence of the problem of medical corruption under the capitalist system, making them victims of the pursuit of profit within the capitalist framework. As Engels recorded in "The Condition of the Working Class in England": the working class lacks access to adequate and affordable healthcare, and the health issues of the working class are not natural or inevitable, but rather the result of the capitalist system, creating a huge gap between the rich and the poor.

Therefore, from a Marxist perspective, the issue of medical corruption is a manifestation of the conflicts and contradictions of interests between the pharmaceutical industry, the medical profession, and the state under the capitalist system, as well as a reflection of the deprivation and harm of the health rights of the oppressed classes. To address the issue of medical corruption, a fundamental overhaul of the medical industry under capitalism is necessary, allowing medical services to truly become a benefit for the people.

Corruption as a Capitalist Phenomenon#

Corruption is an inescapable malignant phenomenon in capitalist society. It is not an accidental error or deviation, but an inherent manifestation of the capitalist system itself. This is because capitalism is built on exploitation and oppression, allowing a small number of people to control the resources of production and distribution, while the majority can only survive by selling their labor. Those who hold resources use their economic and political advantages to extract profits from the value created by workers, thereby increasing their wealth and power. This creates an unequal, unjust, and disharmonious society, where workers are treated as cheap commodities, and their humanity and potential are sacrificed on the altar of profit.

Corruption is a means by which these resource holders maintain and expand their dominance over workers and society. Through corruption, they can intervene in and manipulate the laws, institutions, and policies that should constrain and supervise their power, turning them into tools that serve their interests. Corruption also enables them to buy and influence other social forces, such as politicians, officials, scholars, and the media, to prevent questioning or resistance to their interests. Corruption is also a means to divert public attention and energy away from the problems and crises inherent in the capitalist system itself, blaming them on individual figures or external hostile forces. For example, Turkey's "gas-for-gold" scheme revealed the involvement of President Recep Tayyip Erdoğan and his family, but he denied any wrongdoing and accused their political opponents and external enemies of conspiring against them. In this way, the capitalist system can evade responsibility and reform, continuing to maintain its unreasonable and unsustainable operation.

Marxism posits that society is characterized by class contradictions and class struggles, which are the fundamental driving forces of social development. In capitalist society, the contradictions between the bourgeoisie and the proletariat are particularly sharp. The bourgeoisie controls the means of production and exploits the labor of the proletariat. This exploitation is often realized through various means, with corruption being one of them.

Class Struggle#

In the environment of bureaucratic capitalism, there is a close relationship between large enterprises and the government, forming a special form known as "bureaucratic capitalism." In this environment, the bourgeoisie not only obtains privileges and resources by bribing and corrupting relevant officials but also collaborates closely with the government to gain policy advantages and expand their interests. This behavior not only enhances their wealth and influence but also exacerbates the unequal distribution of social wealth. This inequality concentrates most social resources in the hands of a few, weakening the interests of the majority of the proletariat, severely impacting their quality of life and living environment.

Alienation#

According to Marxist theory of alienation, we can understand it as follows: the value created by laborers is appropriated by capitalists, leading to the alienation of labor's essence. This alienation is reflected not only in laborers losing control over the fruits of their labor but also in their inability to determine their labor processes and conditions. Corruption further exacerbates this alienation, as it undermines the fair distribution of social resources, allowing certain classes to privatize public resources. This privatization of public resources is, in fact, a form of alienation, preventing laborers from fairly enjoying their rights to social resources. Marxism points out that this alienation is caused by the capitalist mode of production, as capitalism pursues profit rather than meeting the needs of the people. Therefore, to eliminate this alienation, it is necessary to change the capitalist mode of production and achieve the public ownership of the means of production and the operation of a planned economy.

Commodification#

Marxism holds that in capitalist society, everything has been commodified, including power. This process of commodification means that power no longer serves the public interest but becomes a tool for certain individuals to gain private benefits. Corruption is an important manifestation of this commodification, as it privatizes and commodifies public power, making it a tool for a few to obtain benefits. This phenomenon reflects the essence of capitalism, which places everything under transactional relationships, and reveals an important contradiction and problem within capitalist society. Marxism argues that this contradiction and problem arise from the existence of two opposing classes in capitalist society—the bourgeoisie and the proletariat. Therefore, to resolve this contradiction and problem, class differences and class struggles must be eliminated.

Marketization and Privatization of Healthcare in China#

According to Marx's perspective, corruption is a manifestation of class struggle and the inherent contradictions within the capitalist system. Corruption arises from the exploitation of labor by capital, the alienation of workers from products, and the commodification of social relations. Corruption is also a means for the ruling class to maintain its hegemony and legitimacy, suppressing the protests and demands of the oppressed classes.

In China, since the late 1970s, the healthcare industry has undergone a process of marketization and privatization as part of broader economic reforms and opening-up policies. The public health system, which once provided universal free medical services to the people, has gradually been replaced by a fee-for-service system reliant on market mechanisms and private providers. The government has reduced its investment and regulation of the healthcare industry while encouraging competition, profit-seeking, and commercialization.

This shift has created fertile ground for corruption in the healthcare industry, negatively impacting the quality, accessibility, and cost of healthcare for the majority of the population. The main forms and impacts of corruption in China's healthcare industry include:

Bribery: Bribery is a widespread practice in the procurement of medical equipment, drugs, and supplies, as well as in patient referrals and treatments. Medical product suppliers often provide kickbacks or commissions to hospital managers, doctors, or procurement officials in exchange for contracts or prescriptions. Patients also have to bribe doctors or nurses or give red envelopes to receive better or faster services, or even to obtain basic services. Bribery increases the costs of medical products and services, lowers quality, and undermines the professional ethics and integrity of medical personnel.
Informal Payments: Informal payments are another common form of corruption in the healthcare industry, referring to unofficial fees demanded or regulated by healthcare providers. Informal payments can be voluntary or coerced and may arise for various reasons, such as gratitude, trust, insurance gaps, or quality assurance. Informal payments are often hidden or disguised as gifts, donations, tips, or fees for additional services. Informal payments increase the financial burden and uncertainty for patients, while also creating inequality and inefficiency in the allocation and utilization of medical resources.
Absenteeism: Absenteeism is a corrupt behavior where medical personnel are absent from work without authorization or justification. Absenteeism may be caused by low wages, poor working conditions, lack of motivation, or engagement in other income-generating activities. Absenteeism reduces the availability and quality of medical services and affects the productivity and performance of medical personnel.
Medical Disputes: Medical disputes involve violent or intimidating behavior where patients or their relatives hire gangs or thugs to disrupt hospital operations or attack medical personnel to extort money or retaliate for alleged medical accidents or negligence. Medical disputes are often triggered by dissatisfaction with medical outcomes, disputes over costs or compensation, or a lack of effective dispute resolution mechanisms. Medical disputes pose a serious threat to the safety and reputation of medical personnel and institutions, undermining trust and communication between doctors and patients.

According to data and statistics from various sources, corruption in China's healthcare industry has reached a concerning level and has adversely affected the health outcomes and well-being of the population. For example:

According to a report by 100Reporters, Chinese resellers representing major Western companies like Siemens, GE, and Philips often submit coordinated high-price bids for critical medical equipment such as MRI and CT scanners. The high prices do not yield excessive profits for multinational companies; rather, they appear to be part of a complex system that conceals bribes to corrupt hospital officials through third-party resellers. The report found that in one hospital in China, a Siemens CT scanner was priced at $3.24 million, while the market price was $1.95 million; a GE MRI scanner was priced at $5.1 million in one hospital, while another hospital paid only half that amount for the same equipment.
According to a Transparency International survey, China ranked 80th out of 180 countries in the perceived corruption index in 2020, with a score of 42 (where 0 indicates high corruption and 100 indicates very clean). The survey also found that 18% of respondents reported paying bribes or giving gifts to obtain public services, such as healthcare, in the past year; 28% reported paying bribes or giving gifts to doctors, nurses, or other healthcare workers; and 35% reported that most or all personnel in the healthcare industry were corrupt.
According to a study by Wang et al., from 2013 to 2015, there were a total of 5,614 mediation records related to medical disputes in Guangdong Province. Among them, 1,995 cases (41%) were resolved through mediation, 1,030 cases were closed through reconciliation, 559 cases were closed by transferring to court, and 1,017 cases were withdrawn after mediation. 505 medical dispute cases were resolved with the help of mediators. The study found that under the existing mechanism, mediation resolved about 90% of medical disputes but required more police support to address medical disputes. The average compensation amount for mediation was 60,200 yuan, and the average duration of mediation was 87 days.
The proportion of health expenditure to household income. According to the National Bureau of Statistics, in 2021, the per capita disposable income of Chinese residents was 35,128 yuan, while per capita health expenditure was 2,416 yuan. This means that health expenditure accounted for 6.9% of disposable income, exceeding the World Health Organization's recommendation of "5%." Among this, personal burden accounted for 28.7% of health expenditure, while government subsidies accounted for 17.9%, and social security accounted for 53.4%. This indicates that Chinese residents still bear a high burden in healthcare, while the government remains insufficient in providing basic public health services.

Limitations and Defects of the Government's Anti-Corruption Campaign#

According to Marx's theory, corruption is a product of the inherent contradictions and exploitation within capitalist society. In this system, a group of bureaucrats and officials serving the interests of the bourgeoisie will emerge, while oppressing the proletariat. Corruption is not merely a moral issue but a structural problem of capitalist society; to resolve this issue, it is necessary to overthrow the capitalist system and establish a socialist society based on public ownership of the means of production and democratic control.

Taking China as an example, corruption is widespread in the healthcare industry. Corruption mainly manifests in forms such as bribery, informal payments, absenteeism, and medical disputes. These corrupt practices lead to increased costs and reduced quality of medical products and services, while also exacerbating the financial burden and uncertainty for patients.

The anti-corruption actions taken by the Chinese government are viewed by some as superficial and ineffective. This is because these actions do not address the root causes of corruption but merely target certain individuals who may be political opponents or scapegoats. Furthermore, these actions do not challenge the dominant position of state-owned enterprises in the economy, nor do they grant workers and the public the rights to participate in decision-making and supervision. The actions are also selective and arbitrary, depending on Xi Jinping's personal will and concentration of power, eliminating checks and balances within the party and the state.

There are facts and reports that support this Marxist critique of the anti-corruption campaign. For example, some studies have found that this campaign has not significantly reduced corruption or improved corporate performance; rather, it has increased political uncertainty and reduced investment efficiency. Another report pointed out that the campaign has created an atmosphere of fear and distrust among officials, leading them to avoid risks and reduce innovation, thereby hindering China's economic development and social stability. Additionally, a Transparency International survey ranked China 80th in perceived corruption, indicating that despite this campaign, corruption remains a serious issue in China.

Therefore, based on Marxist theory and empirical evidence, we can conclude that the Chinese government's anti-corruption campaign is a superficial and ineffective measure that fails to address the root causes and consequences of corruption in China. To resolve the corruption issue, we need to deeply consider the structural problems under the capitalist system and seek ways to establish a socialist society based on public ownership and democratic control. This is also a proposition of Leninism, which emphasizes democracy under the dictatorship of the proletariat, arguing that only when workers and the masses truly hold power can corruption be effectively eliminated.

Conclusion#

This article analyzes the roots of medical corruption from the perspective of Marxist theory, arguing that it is an inherent product of the capitalist system. Marxism posits that corruption is a means by which the bourgeoisie maintains its ruling position, reflecting the inherent contradictions and class struggles within capitalist society.

In contemporary China, the market-oriented reforms in the healthcare industry have provided fertile ground for rampant corruption. Various corrupt practices severely harm the health rights of the working people and increase the financial burden on patients. The anti-corruption actions taken by the government address the symptoms rather than the root causes, failing to fundamentally resolve the issue.

Therefore, we need to recognize that to fundamentally eliminate medical corruption, a thorough change in the socio-economic system is necessary. Only by establishing a socialist state based on public ownership and the leadership of the working class can healthcare truly become a benefit for the people, rather than a tool for capital to pursue profit. We must continuously advance this historical process and strive for the health rights of everyone.