????中國(guó)有句俗話：“常在河邊走,，哪有不濕鞋?！币馑际钦f(shuō)在一個(gè)腐敗的文化里很難獨(dú)善其身,。近日，西方制藥巨頭葛蘭素史克（GlaxoSmithKline）被中國(guó)政府指控涉嫌在中國(guó)進(jìn)行大范圍行賄,，看來(lái)它也一頭掉進(jìn)了臟水里,。

????當(dāng)然，現(xiàn)階段我們聽到的只是一面之辭,，也就是中國(guó)警方對(duì)葛蘭素史克的指控,。所以目前最好謹(jǐn)慎看待這件事，不宜早下定論,。不過(guò)這起指控還是給想在中國(guó)這個(gè)快速增長(zhǎng)的消費(fèi)市場(chǎng)分一杯羹的西方跨國(guó)企業(yè)提出了兩個(gè)重要的挑戰(zhàn),。首先是在中國(guó)這樣一個(gè)潛規(guī)則盛行、反市場(chǎng)政府政策屢見不鮮以及本地企業(yè)習(xí)慣性搞小動(dòng)作甚至直接拉攏腐蝕的環(huán)境里,，西方企業(yè)應(yīng)該怎樣生存。其次是一旦你在中國(guó)取得成功,，占據(jù)了大量市場(chǎng)份額后,，怎樣才能規(guī)避中國(guó)的保護(hù)主義措施。

????對(duì)于第一個(gè)問(wèn)題,，葛蘭素走運(yùn)的地方就在于選擇了一個(gè)正確的生意上，因?yàn)橹袊?guó)對(duì)西方藥品的需求是巨大的,；但它倒霉的地方就在于它必須得在一個(gè)融資模式功能失調(diào)的醫(yī)藥體系里混飯吃,，而在這個(gè)體系里,，好人也會(huì)被迫變成壞人。從數(shù)字上看,，中國(guó)的醫(yī)藥市場(chǎng)市值目前大概在4,000億美元左右，而到2020年,，這個(gè)市場(chǎng)的規(guī)模將達(dá)到10,000億,，是任何一個(gè)西方制藥企業(yè)都不能忽視的市場(chǎng),。2012年,，中國(guó)市場(chǎng)的藥品銷量達(dá)到820億美元，其中包括約100億美元的進(jìn)口藥品,。西方制藥企業(yè)以及1,500多家合資公司通過(guò)進(jìn)口和合資生產(chǎn)等方式在中國(guó)市場(chǎng)上攫取了巨大的市場(chǎng)份額。在大多數(shù)大城市里,，他們的銷量占總銷量的比重高達(dá)60%至65%,。

????不幸的是,，西方制藥企業(yè)也必須忍受中國(guó)醫(yī)藥行業(yè)的黑暗面,。中國(guó)政府為醫(yī)藥行業(yè)選擇了一種世界上獨(dú)一無(wú)二的融資模式，通過(guò)高藥價(jià)來(lái)補(bǔ)貼醫(yī)療,。公立醫(yī)院一般有三大收入來(lái)源：政府撥款,、醫(yī)療服務(wù)、賣藥,。政府撥款只占中國(guó)公立醫(yī)院預(yù)算的10%,。為了讓老百姓看得起病，政府把醫(yī)療服務(wù)的價(jià)格定得很低,。醫(yī)院要提供這些服務(wù),，就注定要賠錢。為了使醫(yī)院運(yùn)轉(zhuǎn)得下去,，中國(guó)政府允許醫(yī)院高價(jià)賣處方藥,。結(jié)果來(lái)自賣藥的收入一般會(huì)占城市公立醫(yī)院收入的40%到50%，在農(nóng)村,，這個(gè)比例還要高得多,。

????這種融資模式通過(guò)藥價(jià)推高了老百姓的醫(yī)療成本，同時(shí)鼓勵(lì)了腐敗,。為了在這個(gè)有利可圖的市場(chǎng)上搶一塊蛋糕,，很多制藥企業(yè)都通過(guò)賄賂醫(yī)生來(lái)讓他們給病人開自家公司的處方藥。根據(jù)中方的指控，葛蘭素史克通過(guò)“召開”不存在的會(huì)議,，替醫(yī)生報(bào)銷根本不存在的“差旅費(fèi)”,，可見葛蘭素史克也走了邪路,，而且顯然遭到了更嚴(yán)格的處理,。

????之前，葛蘭素史克已經(jīng)有過(guò)幾次行賄史了,，所以似乎不值得同情,。不過(guò)由于中國(guó)社會(huì)的腐敗無(wú)處不在，加上中國(guó)醫(yī)療行業(yè)的融資模式如此不合理,，在現(xiàn)實(shí)逼迫下,，葛蘭素史克以及其他西方制藥企業(yè)可能毫無(wú)選擇的余地，只能被迫混水摸魚——除非他們決定遠(yuǎn)離中國(guó)這個(gè)蓬勃發(fā)展的醫(yī)療市場(chǎng),。

????"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.