HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, July 23, 2013

Income Maintenance Among Chinese Doctors

Journalists have repeatedly made the case that physicians should earn less.  The question then becomes: how will doctors react once their pay is cut?  China provides some interesting examples

Bribery is the lubricant that helps keep China's public hospitals running, and the health system would struggle to function without illegal payments to poorly paid doctors and administrators, say medical practitioners and industry experts.

The corruption stems largely from doctors' low base salaries, which are set in line with a pay scale for government workers. Hospitals can pay bonuses but, given public hospitals are strapped for cash, compensation is usually low, say doctors and industry experts.

Low salaries have also spawned a system of under-the-table payments from patients. The payments are known as "hongbao" -- a reference to the cash-filled red envelopes given as presents during Lunar New Year festivities -- and cover various services from jumping the queue for appointments to extra surgical fees.

I predict we'll soon be seeing a concierge medicine firm called "Red Envelope" springing up in the USA.  More seriously: have America's health care cost cutters seriously considered the potential unintended consequences of their crusade?  We live in a world where Wall Street compensation has skewed expectations generally.  "Only 28 percent of those worth $1 million to $5 million said they were wealthy," according to a recent survey.  I don't predict many specialists are going to miss out on a chance to join the $5 million+ crowd.  Health care cost cutters may simply be encouraging them to shift their energies away from ordinary Medicare and Medicaid patients, and toward the worried wealthy.


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