Capsules on display at a pharmaceutical exhibition in Nanjing, Jiangsu province. The government's control of the price-setting system is a major cause of the high cost of drugs, some experts say. [An Xin / For China Daily]

The cost of medication is expected to continue on an upward path

BEIJING - His working hours are different from those of most people. He starts before 8:00 am, saying hello to his clients. He spends the rest of the morning catching up on other items, and then has a working lunch or chats with his clients at noon. In the afternoon, he either attends professional conferences and meetings or rests. Then in the evenings, he attends business dinners with clients, maybe followed by drinks and some karaoke.

Feng Bin, 28, is always in close contact with his clients - hospital doctors. He is a medicine representative for a multinational pharmaceutical company. He graduated from a national-level medical university in Beijing three years ago and has a master's degree. He's not complaining about his remuneration package either - his basic monthly salary is 3,000 yuan ($472), plus a performance-linked monthly bonus of between 3,000 and 6,000 yuan and a yearly bonus which can be as much as tens of thousands of yuan, plus subsidies for transport and telecommunications.

However, he says he doesn't feel good that doctors receive money for prescribing the medications he promotes, or at witnessing patients paying over the odds for a drug selling at several times more than its manufacturer's price.

Liu Yuan, Feng's former classmate, has been working at a major State-owned hospital in Beijing for three years. She told China Daily that she has received money from Feng: After all, he promotes treatments for high blood pressure and Liu works in a cardiovascular unit.

"Our doctors do have many choices when prescribing medicines, from domestically produced drugs to products by foreign companies," said Liu. "His (Feng's) company is a big international drugmaker, the brand is reliable, our patients like products from foreign companies and he is an old friend. Although all drugmakers offer rebates (commission to doctors who prescribe the company's products), I, of course, choose what Feng recommended. Why not?"

However, when asked if she would swap brands if another company offered a larger rebate than Feng's, she did not answer.

Liu's monthly salary is between 4,000 and 5,000 yuan when basic and performance-related payments are added together. "It (receiving rebates for pharmaceutical sales) is very common in hospitals. I have not accurately calculated how much I can earn every month. But I don't think it's more than my salary," Liu said.

Jiang Bingkun, 58, is Liu's patient. He has been suffering from high blood pressure for more than 10 years and has to take medication on a daily basis. Over the past few years, his monthly expenditure on drugs has increased to more than 300 yuan, from around 40 yuan in 2001, the Beijinger said.

"I noticed that the government set up lists of basic drugs and forced reductions in the prices of some medications for chronic diseases, which is really good. However, I have found that some cheap and effective medicines are not available at the hospital anymore. So, in general, my expenditure on medication hasn't fallen at all," he said, adding that doctors sometimes recommend new treatments to him, saying the new products are more effective and have fewer side-effects.

"I am really confused. It's difficult to make a decision, because, at my age, my health is the top priority, more important than money. On the other hand, I don't know that the drugs they recommended - usually the higher-priced ones - are really as good as they said or whether the doctors have received money to promote the new products," Jiang said.

The prices of medicines in hospitals are much higher than in the factories, sometimes as much as 10 times higher, according to investigations by some Chinese media. The case of Clindamycin phosphate, a treatment for chronic bronchitis, provides an effective example: The manufacturer's price is 0.6 yuan, but the injection is sold to the pharmaceutical representatives by distributors for 4 yuan. The price of the drug on Beijing's essential drug list (EDL) is 11 yuan, but it is sold to patients at top hospitals for 12.65 yuan.

Many people have claimed that the pharmaceutical companies, medicine representatives, hospitals and doctors are driving up the prices and earning fat profits.

On Dec 1, the National Development and Reform Commission (NDRC), which is authorized to set prices, launched a nationwide investigation into the pricing of medicines.