Abstract
China’s massive anti-corruption campaigns have not eliminated medical corruption; instead, corrupt practices in public hospitals have evolved into more sophisticated and concealed forms. While existing research largely employs quantitative or system-level analyses, ethnographic studies of corruption’s everyday mechanisms remain limited. This study addresses this gap through a longitudinal ethnographic study of pharmaceutical procurement corruption in Xi’an (2017–2024). It identifies three mechanisms that have emerged under shifting governance: (1) manipulation of hospital drug listing processes through artificial scarcity and concentrated gatekeeping, (2) exploitation of prescription data via information asymmetries, and (3) misuse of academic conferences through institutional disguise by professional intermediaries. The findings show that while traditional bribery has become prohibitively risky under strengthened oversight, corrupt practices persist by reorganising into targeted, concealed, and strategic forms. These dynamics illustrate corruption’s evolutionary intelligence, enabling networks to maintain equilibrium across institutional, temporal, and cultural contexts. The study argues that corruption in China’s health sector functions as a resilient adaptive system, challenging deterrence-focused reforms and underscoring the need for policies that address the informal logics and strategic manoeuvres sustaining corruption.
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Excerpt
Full text document will be published online on March 2027.
Outline
Theoretical foundations and ethnographic understandings in corruption studies
Research methods
Manipulation of hospital listing processes
Case 1: “We were fortunate that the right time, place, and people have helped us succeed in getting our new drug listing!” (April 2024)
Case 2: “I didn’t expect the competition to be so fierce!” (April 2024)
Exploitation of prescription data
Misuse of academic conferences under the guise of association-authorised projects
Discussion
Conclusion
First lines
Medical corruption is a pervasive global issue, but China’s health sector – shaped by a historically specific reform trajectory and persistent institutional contradictions – presents a particularly compelling case. Informal practices such as yiyao yangyi 以藥養醫, whereby pharmaceutical sales supplement both hospital and physician incomes, have evolved into deeply entrenched rent-seeking systems (Ge and Gong 2007; Yip et al. 2010; Li 2021; Dai 2023). Earlier studies have documented how financial imperatives, decreased government subsidies, and below-market medical service prices push hospitals to rely on drug sales for as much as 40% of their revenue (Xu et al. 2019; Gong et al. 2023). Although large-scale anti-corruption campaigns and new oversight structures have curbed overt bribery, these measures have largely targeted symptoms rather than transforming the underlying incentive frameworks (Ma et al. 2019; Fu et al. 2023).
Much of the existing literature approaches corruption in China’...
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References
Bibliographical reference
Fen Dai and Woojong Moon, “Evolving Dynamics of Medical Corruption Driven by Changing Governance in China’s Public Hospital Reforms”, China Perspectives, 144 | 2026, 65-76.
Electronic reference
Fen Dai and Woojong Moon, “Evolving Dynamics of Medical Corruption Driven by Changing Governance in China’s Public Hospital Reforms”, China Perspectives [Online], 144 | 2026, Online since 01 March 2027, connection on 17 May 2026. URL: http://journals.openedition.org/chinaperspectives/20168; DOI: https://doi.org/10.4000/15zui
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About the authors
Fen Dai is Assistant Professor in the School of Health Services Management, Xi’an Medical University, China (daifen@xiyi.edu.cn).
Woojong Moon is Assistant Professor in the College of Nursing, Hanyang University, Seoul, South Korea (wjmoon1@gmail.com).
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