The GSK Scandal: When Questionable Global Practices Met Imperfect Institutions in Emerging Markets
China's healthcare reforms in the 1980s left the country's hospitals under-subsidized and its medical officials underpaid. Hospitals relied on profits generated from the provision of medical services to cover the funding gap, while doctors became kickback seekers to make up for their low rates. In traditional markets, global pharmaceutical companies ("pharm companies") are no strangers to wooing hospitals and doctors to favor prescriptions of their drugs. These questionable "marketing" practices were taken to the next level in the China market. Streams of financial flows, legal or not, from pharm companies to hospitals and doctors to win their favor in prescribing their drugs became a structurally embedded problem of the country's healthcare system. The Chinese government introduced a new round of reform in 2009. While it promises to spend millions more on healthcare, its action to wipe out bribery and other kickback-seeking behaviors of the industry left many players perplexed. The first to take the heat was GlaxoSmithKline Inc. ("GSK"), a large British pharm company active in the China market since 1984. In July 2013, the Chinese government launched an investigation on GSK's China operation regarding its activities that lure hospitals doctors and administers to buy GSK drugs. The alleged practice of bribery is an industry open secret common to pharm companies. Is this investigation an indication that the Chinese government is targeting multinationals in favor of local players? Despite high-voltage growth rates, this regulated industry in the market economy with Chinese characteristics only has a bare-boned distributions infrastructure, while it is filled with patient-trying administrative hurdles, has price restrictions on an expanded list of drugs, and offers weak institutional protection for companies' intellectual property. Will long-term investment in the country pay off? Should GSK continue its China business? Should it change its strategy in China?