Benefit gainers

The public is also left wondering who's making the money from the price gap.

With relation to the commission paid to hospitals, Zhuang said that many State-owned non-profit hospitals simply don't get sufficient fiscal investment from the government. Therefore, the 15 percent commission from the purchase of medicines is mainly used to support infrastructure renovation, technological upgrades and academic training.

However, Zhuang also said that the hospitals have to toe the line with the NDRL and EDL and are not allowed to decide which medicines to buy. Even though the hospitals may know of high-quality, affordable medicines, if they're not included in the lists, the hospitals are simply not allowed to purchase them.

China's hospital sector has seen strong sales growth since 2003, with growth constantly boosting sales, calculated by dividing the actual sales in any given year by the price index of that year.

Sales in hospitals jumped to 211.77 billion yuan last year from 49.15 billion yuan in 2003, an average annual increase of around 20 percent, according to a report from IMS Health, an international healthcare researcher.

The IMS report said that sales growth in hospitals has been driven by the buoyant economy, the rapidly rising standard of living in urban areas, and the high prescription levels in hospitals dependent on income from pharmaceutical sales.

That growth was given additional impetus by the government's program of healthcare reform launched in 2009. Additional funding of 12.3 billion yuan in support of the local healthcare reform initiative was allocated in late 2010, on top of the 850 billion yuan allocated to finance the reforms between 2009 and 2011.

The report forecast that the robust growth of the hospital sector is expected to continue. However, it is expected to slow gradually, given that there will be a new NRDL and price reductions for the drugs included in it, and a reduction of the price differential between off-patent originators and local generic products.

Liu is one of 2 million-plus doctors in China. After an eight-year university education, she began working at a State-owned hospital in 2009. "Compared with my education costs and what I do I treat about 50 patients every day and have little time to do anything else I believe the salary is too low. However, I don't want to give up my career," she said.

The young doctor, who at 27 looks as though she's in her 30s, was dressed simply and worn no make-up. She ate the contents of her lunch box - egg-fried rice with vegetables - during her one-hour noon break as she read her micro blog. She can only do this at lunchtime or at the weekends, because she attends training courses every evening from Monday to Friday. Meanwhile, she's also preparing for further study overseas.

"Being a doctor is a very tough job in China. I plan to continue my career overseas, hoping for at least a decent income and reasonable working pressure," Liu said, taking a sip of tea from a stainless steel vacuum mug bearing the name of a medical treatment and the logo of the drug maker, while playing with a pen adorned with the name of a different drug and company, despite a card on her desk that read: "No pharmaceutical sales."

After lunching with the director of a cardiovascular unit, Feng went home for a short rest. "If you could take the heat and enjoy the bonuses offered by most good companies, the job (medicine sales) could be really flexible and offer many opportunities," he said.

Feng admitted that when looking for jobs prior to graduation, income was one of the key elements he took into consideration. Meanwhile, he believed that a job in medicine sales would help overworked doctors and save their time by keeping them up to date with the latest industry developments. "However, I don't think that is what I am doing now, except for some professional lectures - and they are mainly aimed at promoting a medicine," he said.

What makes him most frustrated and depressed is people's attitudes, especially those of doctors and patients. "I have a sound educational background, I have undergone strict and tough training in medication and sales skills, and I am serving a global top-500 company, but I still feel humble," said Feng. "Anyway, the money is good compensation and a nice recognition of my work."