New protesters arrive every couple of minutes at the unmarked gates of the Ministry of Health in Beijing, coming in the faint hope that the national authorities will be able to help where their local hospitals and clinics have failed.

在北京那座没有标识的中国国家卫生和计划生育委员会大院的门口，每几分钟就会新来一些心怀一丝希望的抗议者，他们希望国家级别的主管部门能帮他们解决当地医院和诊所解决不了的问题。

One young mother carries a tattered notebook full of medical records, baby ultrasounds and official letters. She says she is trying to get treatment for her son, now aged eight, who has organ damage after drinking toxic infant formula as a baby. Another young woman unfurls graphic pictures of her injuries after a violent beating by police, and says she is here to protest against a local hospital that refused to treat her.

一位年轻母亲拿着一个破烂不堪的笔记本，里面夹满了病历、婴儿超声波检测结果和官方信件。她表示，她正争取让儿子得到治疗。她儿子今年八岁，由于小时候喝了有毒的婴幼儿配方奶粉，致使器官发生病变。另一位年轻女士则展示了一些照片，显示她因警察殴打身上伤痕累累，她表示来这里是为了抗议当地医院拒绝为她治疗。

Extreme underfunding and overcrowding mark the Chinese medical system. Its dysfunctions also spawn rampant abuses and corruption that can make it a treacherous place for drug companies. As pressures rise on the Chinese government to act over poor healthcare quality and rising healthcare costs, officials have embarked on round after round of crackdowns and investigations into hospitals, doctors and drug companies.

资金极度匮乏和医院人满为患，是中国医疗体系的特征。这一体系运转不良，滋生了猖獗的滥用职权和腐败现象，很可能成为医药企业的陷阱。中国政府面临日渐增大的压力，要向医疗质量低劣和医疗成本攀升“开刀”，官方已展开一轮又一轮针对医院、医生和药企的调查和打击行动。

It is against this background that the Chinese authorities this week accused UK drugmaker GlaxoSmith-Kline of being the ringleader in a half-a-billion-dollar bribery scandal involving 700 companies.

正是在这个背景下，本周中国官方指控英国制药公司葛兰素史克 (GSK)是一起牵涉700家企业、5亿美元贿赂丑闻的领头者。

GSK said in a statement on Monday that it was “deeply concerned and disappointed by these serious allegations” raised by Chinese police, and had “zero tolerance for any behaviour of this nature”.

GSK本周一发表声明称，对中国警方提出这些的“严重指控深表关切与失望”，“对此类行为绝不姑息和容忍”。

At the same time as the small group of petitioners was waiting at the ministry’s gates under the hot Beijing sun yesterday, Chinese TV stations across the country were lit up with the face of a man named Liang Hong, who was describing alleged practices by GSK that he said led to higher drug prices.

昨天，就在少数请愿者在北京炎炎烈日之下苦苦等候之时，中国各地电视台都在播放对一位名叫梁宏的男士的采访。他在电视上描述了GSK所涉不当行为，并表示这些行为推高了药品价格。

Mr Liang was GSK’s operations manager in China and is being detained by police as part of their investigation into alleged bribe taking and bribe giving by GSK’s China business. He told Chinese TV that he had used travel agencies to put through expenses “money that we spent when dealing with government departments that we couldn’t normally claim through our company”.

梁宏是GSK中国的企业运营总经理，目前已被警方拘留，正接受GSK中国涉嫌受贿与行贿的调查。他告诉中国的电视台，他利用旅行社完成“打点政府部门时所花开销的走账，这类开销通常无法向公司报销”。

“Through my reflections in the last 10 days, I realised that the prices of drugs were raised by the cost of these sorts of operations,” he said contritely.

他充满悔恨地表示：“经过最近十天的思考，我认识到，药品价格正是被这类活动的开销推高的。”

While Chinese media have been occupied with details of the investigation into GSK, for many viewers the high-profile bribery investigation is just another example of the dysfunction of their healthcare system.

尽管中国媒体充斥着对GSK调查的细节，许多观察者认为，这次对商业贿赂的高调调查只是彰显中国医疗体系功能失调的又一个案例。

Whether it is doctors who ask for bribes before performing surgery, clinics that kick out cancer patients near the end of their lives to save money or drug companies giving kickbacks to doctors, stories of malpractice in China’s healthcare system are rife.

不论是手术前索要贿赂的医生，为节约资金而把濒死的癌症患者赶走的诊所、还是向医生支付回扣的药企，中国医疗体系中的不当做法屡见不鲜。

With scanty insurance coverage, a shortage of doctors, too few clinics in rural areas and poor regulation, working people’s lack of access to affordable healthcare in China has for years been a simmering source of discontent.

由于保险覆盖面不够，医生匮乏，农村地区医院过少以及监管不到位，务工人员看不起病，已成为多年来引发社会不满的一个潜在原因。

Since 2009, Chinese authorities have been trying to address this through a reform programme, which has included building more hospitals, extending insurance coverage and doubling state spending on healthcare. Despite the improvements brought about by these schemes, out-of-pocket payments made by Chinese patients are still among the highest of any major economy, averaging close to 40 per cent of treatment costs.

自2009年以来，中国官方一直试图通过一项改革解决这个问题，具体措施包括兴建更多医院、扩大医保覆盖面以及将国家医疗开支提高一倍。尽管这些举措确实令局面有所改善，但中国患者自行负担的医疗费用仍然是世界主要经济体中最高的，平均接近治疗总费用的40%。

One of the most intractable problems has been funding for Chinese hospitals, which operate under artificially low state-controlled prices and fees, but are largely responsible for covering their own costs.

最难处理的一个问题是中国医院的资金短缺。在中国政府控制下，药品定价和医疗费用被人为压低，而医院的大部分开销却要由自己筹措。

As a result, most hospitals rely on drug sales through the site pharmacy for most of their profits. Routine over-prescription of drugs is the result. In 2010, Chinese authorities punished more than 15,000 cases of improper drug pricing or over-prescription, amounting to Rmb180m of illegal income for hospitals.

结果是，多数医院只能通过销售药品来取得大部分盈利，这导致医生过度开药成为惯例。2010年，中国官方处罚了逾1.5万起药品不当定价或过度开方行为，医院从中非法获利总计1.8亿元人民币。

“It’s very hard to remove the malignant tumour in this policy,” said Zhou Xiaoqin, professor at Beijing University of Chinese Medicine. “How can public hospitals survive without their dependence on drug sales? If the authorities don’t make the compensation mechanism work in a reasonable way, it’s actually forcing the good guys to be bad people.”

北京中医药大学卓小勤教授表示：“这种政策下很难根除这一毒瘤。公共医院不靠卖药如何生存？如果官方不能建立合理的薪酬机制，这实际上是在逼良为娼。”

Payment by drug companies to doctors and hospitals for prescriptions is standard practice in China, according to industry executives and analysts. A recent study by consultancy LEK estimated that “incentives” provided to doctors for generic drug sales are typically equivalent to 40-50 per cent of the final drug price paid by patients.

业内高管和分析人士表示，在中国，药企给多开药的医生和医院好处，已成为一种惯常做法。根据咨询公司LEK最近一项研究的估算，医生因非专利药品销售而获得的“激励”，往往占到患者最终支付药品价格的40%到50%。

“China does not permit bribery . . . But it is generally widely known that there are cash payments in envelopes made to doctors,” said Helen Chen, pharmaceutical specialist at consultancy LEK. Hospital sponsorship programmes, rebates and sponsorship for academic conferences were also common forms of incentives provided by drug companies to doctors, she said.

咨询公司LEK的医药专家Helen Chen表示：“中国并不允许贿赂行为……不过几乎人人都知道，有人会通过信封给医生塞钱。”她表示，制药公司激励医生的常见手段还包括医院赞助项目、回扣和赞助学术会议。

A former pharmaceutical executive in China said the police allegations against GSK sounded like practices that were “common” for many companies operating in China.

一位曾在中国担任过药企高管的人士表示，警方对GSK的指控，听起来像是许多在华运营的企业都会采取的“常见”做法。

“The older generation of doctors are so used to receiving such a low salary that [a bribe] was the only way they could receive extra salary,” the executive said. “There was always the fear at multinationals that some disgruntled employee who wanted revenge would leak it to the press.”

这位前高管表示：“老一代医生对于这么低的薪水是如此习以为常，结果（贿赂）成为他们获取额外报酬的唯一途径。在跨国公司，总有人害怕部分心怀不满的员工想要报复，把这些事捅给媒体。”

China’s fragmented drug licensing system also provides ample opportunity for rent seeking. For the most common drugs used in hospitals, companies must win the right to sell their products by bidding in tenders in each province separately.

中国多头管理的药品许可证制度也滋生了大量寻租机会。对于医院最常用的药品，药企必须分别在每个省份通过竞标获得销售其产品的权利。