葛兰素史克行贿门折射中国经商风险

    中国有句俗话：“常在河边走，哪有不湿鞋。”意思是说在一个腐败的文化里很难独善其身。近日，西方制药巨头葛兰素史克（GlaxoSmithKline）被中国政府指控涉嫌在中国进行大范围行贿，看来它也一头掉进了脏水里。

    当然，现阶段我们听到的只是一面之辞，也就是中国警方对葛兰素史克的指控。所以目前最好谨慎看待这件事，不宜早下定论。不过这起指控还是给想在中国这个快速增长的消费市场分一杯羹的西方跨国企业提出了两个重要的挑战。首先是在中国这样一个潜规则盛行、反市场政府政策屡见不鲜以及本地企业习惯性搞小动作甚至直接拉拢腐蚀的环境里，西方企业应该怎样生存。其次是一旦你在中国取得成功，占据了大量市场份额后，怎样才能规避中国的保护主义措施。

    对于第一个问题，葛兰素走运的地方就在于选择了一个正确的生意上，因为中国对西方药品的需求是巨大的；但它倒霉的地方就在于它必须得在一个融资模式功能失调的医药体系里混饭吃，而在这个体系里，好人也会被迫变成坏人。从数字上看，中国的医药市场市值目前大概在4,000亿美元左右，而到2020年，这个市场的规模将达到10,000亿，是任何一个西方制药企业都不能忽视的市场。2012年，中国市场的药品销量达到820亿美元，其中包括约100亿美元的进口药品。西方制药企业以及1,500多家合资公司通过进口和合资生产等方式在中国市场上攫取了巨大的市场份额。在大多数大城市里，他们的销量占总销量的比重高达60%至65%。

    不幸的是，西方制药企业也必须忍受中国医药行业的黑暗面。中国政府为医药行业选择了一种世界上独一无二的融资模式，通过高药价来补贴医疗。公立医院一般有三大收入来源：政府拨款、医疗服务、卖药。政府拨款只占中国公立医院预算的10%。为了让老百姓看得起病，政府把医疗服务的价格定得很低。医院要提供这些服务，就注定要赔钱。为了使医院运转得下去，中国政府允许医院高价卖处方药。结果来自卖药的收入一般会占城市公立医院收入的40%到50%，在农村，这个比例还要高得多。

    这种融资模式通过药价推高了老百姓的医疗成本，同时鼓励了腐败。为了在这个有利可图的市场上抢一块蛋糕，很多制药企业都通过贿赂医生来让他们给病人开自家公司的处方药。根据中方的指控，葛兰素史克通过“召开”不存在的会议，替医生报销根本不存在的“差旅费”，可见葛兰素史克也走了邪路，而且显然遭到了更严格的处理。

    之前，葛兰素史克已经有过几次行贿史了，所以似乎不值得同情。不过由于中国社会的腐败无处不在，加上中国医疗行业的融资模式如此不合理，在现实逼迫下，葛兰素史克以及其他西方制药企业可能毫无选择的余地，只能被迫混水摸鱼——除非他们决定远离中国这个蓬勃发展的医疗市场。

    "If you walk along the river often," the Chinese are fond of saying, "you cannot avoid getting your shoes wet." This aphorism refers to the difficulty of staying clean in a corrupt culture. GlaxoSmithKline (GSK), the Western pharmaceutical giant recently accused by the Chinese government of engaging in a massive bribery scheme in the country, seems to have fallen headlong into the dirty water.

    Of course, at this stage, we are hearing only one side of the story -- the allegations against GSK by the Chinese police. So it would be prudent to withhold judgment on this specific case.

    Nevertheless, the allegations against GSK raise two important challenges for Western multinationals eager to take advantage of China's fast-growing consumer market. The first one is how to survive in an environment with unclear rules, anti-market government policies, and local competitors habitually engaging in unethical or outright corrupt practices. The second one is how to ward off protectionist measures once you become successful and gain a significant share of the Chinese market.

    As for the first question, GSK has the good fortune of being in the right business (there's significant demand for Western pharmaceuticals in China) but the bad luck of having to work in a health care system with a dysfunctional financial model that forces honest people to be crooks. Judging by the numbers, the Chinese health care sector, a roughly $400 billion market expected to reach $1 trillion by 2020, is one no Western pharmaceutical firm can afford to ignore. Sales of pharmaceutical products in China in 2012 reached $82 billion, including roughly $10 billion of which were imported drugs. Western pharmaceutical firms, which also have over 1,500 joint ventures in China, have gained enormous market share with both imports and locally manufactured drugs. In most large cities, they account for 60-65% of the sales.

    Unfortunately, Western pharmaceutical firms must live with the dark side of the health care industry in China. Unique in the world, the Chinese government has opted for a financing model that relies on high drug prices to subsidize health care. There are three income streams for public hospitals: government appropriations, medical services, and prescription drugs. The government provides only 10% of the budget of Chinese public hospitals. To make health care accessible, the government keeps the prices of medical services very low. Hospitals lose money providing such services. To keep hospitals afloat, Beijing allows them to charge high prices on prescription drugs. As a result, income from prescription drugs accounts for 40-50% of a public hospital's income in the cities and a much higher percentage in the countryside.

    This financial model pushes up health care costs (through excessive prescriptions) and encourages corruption. To get a piece of the lucrative market, pharmaceutical firms have resorted to bribing doctors to prescribe their products. GSK, which is apparently subject to more strict internal rules, opted to travel a tortuous route, according to China's allegations: holding fictitious conferences that reimburse doctors' non-existent travel expenses.

    GSK, with its checkered history of corruption scandals, seems to deserve little sympathy. However, given the pervasive corruption in Chinese society and the irrational health care financing model, GSK -- along with other Western pharmaceutical firms -- may have little choice but to dip into murky waters – unless they stay far away from the proverbial river of profits of China's burgeoning health care market.