A rare display of public anger is unfolding in China over the quality of domestically produced drugs.

围绕国产药品质量问题，中国民众的愤怒情绪正在罕见地爆发。

A prominent Shanghai surgeon pointed to anesthetics that do not put patients to sleep. A respected Beijing cardiologist questioned blood pressure medication that failed to regulate. A former editor at a leading online health platform went as far as to accuse domestic drugmakers of fraud.

上海一位著名外科医生指出麻醉药不能使患者入睡。北京一位受人尊敬的心脏病专家质疑降压药无法调节血压。一家著名在线健康平台的前编辑甚至指责国内制药商存在欺诈行为。

The concerns spilled out into public discussions this week when some top doctors and hospital leaders called on the government to change how it buys drugs for its public hospitals.

上周，一些顶级医生和医院领导呼吁政府改变公立医院的药品采购方式后，这种担忧开始引发公众讨论。

The outburst of scrutiny, unusual in a country where the authorities keep a tight grip on public criticism of the government, was a rebuke of Beijing’s campaign to lower medical costs. Officials are working to shore up China’s national health care system, which is under financial pressure in part because of a rapidly aging population.

在中国当局严格控制公众对政府的批评的情况下，这种公共监督的爆发并不常见，这是对北京降低医疗成本运动的谴责。官员们正在努力支撑中国的国家医保系统，该系统面临财政压力，部分原因是人口迅速老龄化。

The policy, which was put in place in 2018, encourages fierce competition between drug manufacturers and has been successful at sharply driving down drug prices. But this year, foreign-branded drugs were largely absent from the government list of medicines that are covered under China’s national health insurance and offered at public hospitals.

这项政策于2018年开始实施，鼓励药品制造商之间激烈竞争，成功大幅压低了药品价格。但今年，外国品牌药品基本没有出现在中国国家医保覆盖的药品清单和公立医院提供的药品清单上。

The change has effectively pushed out many foreign pharmaceutical companies that do not want to compete against Chinese companies willing to sell their drugs at rock-bottom prices.

这一变化实际上已经将许多不愿意与中国公司竞争的外国制药公司挤出了市场，这些中国公司愿意以极低的价格出售药品。

Now, doctors are sounding the alarm about the efficacy of some of the domestic drugs. The doctors are seeking changes to give patients the choice to pay more for alternatives.

现在，医生们对部分国产药物的疗效发出了警告。医生们正在寻求改变，让患者可以选择支付更多费用购买替代药物。

“There have always been grumblings that if you cut the price, manufacturers will cut corners,” said Helen Chen, a managing partner and health care expert at L.E.K Consulting in Shanghai. “Now there are some public voices saying it is happening.”

“一直有人抱怨说，如果降价，制造商就会偷工减料，”上海的艾意凯咨询主管合伙人、医保专家陈玮表示。“现在很多人说这种情况正在发生。”

After years of failing to reduce costs, the government created a central bidding system that favored cheaper drugs, which in most cases have been generics made by Chinese companies. In exchange, the government guaranteed to purchase more from each supplier.

多年来，政府一直未能降低成本，于是建立了一个集中招标系统，该系统倾向于廉价药品，这些药品大多是中国公司生产的仿制药。作为交换，政府保证从每个供应商处购买更多药品。

Public hospitals account for about 70 percent of China’s drug market. Patients who use private clinics have easier access to a wider choice of medication, including foreign brands.

公立医院占据中国药品市场的约70%。使用私人诊所的患者更容易获得更广泛的药物选择，包括外国品牌。

The annual bidding system, known as volume-based procurement, has more than halved the price of most drugs and saved Beijing over $50 billion its first five years, according to the most recent available government data.

根据最新的政府数据，年度招标系统（即集采）已使大多数药品价格降低了一半以上，并在第一个五年内为北京节省了4400亿元。

“The national procurement system does keep prices down,” said Zheng Minhua, the director of surgery and the prestigious Ruijin Hospital in Shanghai, in a video interview by a local state media outlet.

“集采确实是把价格压低了，”上海著名的瑞金医院普外科主任郑民华在接受当地官方媒体的视频采访时表示。

But, he added, “at such a low price, the quality of the drug may be unreliable,” citing several examples including antibiotics that have caused allergies, blood pressure medication that did not lower blood pressure and laxatives that failed to do their job.

但他补充道，“在这么价格低的情况下，药物质量可能不稳定”，并举了几个例子，包括抗生素过敏、血压不降和泻药不泻。

2023年，北京一家儿童医院外。公立医院占中国药品市场的70%左右。

Dr. Zheng was among more than 20 doctors and Communist Party members who submitted a proposal this week to the government that would allow patients to get an original branded drug even if it was not on the approved procurement list. Insurance reimbursement would be adjusted depending on whether the drug was from an original branded drug or a generic.

上周，有20多名医生和共产党员向政府提交了一份提案，郑民华医生是其中的一位。提案提出允许患者获得原研品牌药，即使该药不在批准的采购名单上。保险报销将根据该药是原研品牌药还是仿制药进行调整。

The head of cardiology at Beijing Chaoyang Hospital, Lu Changlin, submitted a similar proposal suggesting that doctors and patients should not be forced to use the drugs on the procurement list.

北京朝阳医院心脏内科主任卢长林也提出了类似提案，建议不要强制医生和患者使用集采清单上的药品。

The growing pushback from the medical community has been so strong that China’s National Healthcare Security Administration, which is responsible for national medical insurance, dispatched officials to Shanghai to speak to doctors and examine clinical data for the drugs.

由于医学界的反对声音越来越强烈，负责国家医保的中国国家医疗保障局派官员前往上海与医生了解情况，并检查这些药物的临床数据。

“There is no regulation banning the purchasing or use of imported and branded drugs,” it said in a statement this week.

该部门本周在一份声明中表示：“无‘一刀切’不允许采购使用‘进口原研药’的制度安排。”

After the public outcry, some medical professionals have begun to examine the trials for some generic drugs. In a post on social media, Xia Zhimin, a doctor at Hangzhou Hospital of Traditional Chinese Medicine, compared data from the trials of original drugs with those of the same drugs in generic form and found too many similarities, raising questions about whether the data was fraudulent, Dr. Xia said.

在公众的强烈抗议之后，一些医疗专业人士开始审查一些仿制药的试验。杭州市中医院的夏志敏医生在社交媒体上的一篇帖子中比较了原研药的试验数据和仿制药的数据，发现有太多相似之处，这引发了人们对这些数据是否存在欺诈的质疑。

“The numbers are exactly the same down even to two decimal places,” wrote Dr. Xia, the former deputy editor in chief of Ding Xiang Doctor, a popular online forum for medical professionals.

“连小数点后两位的数据都完全一样，”曾任热门医疗专业人士在线论坛“丁香园”副主编的夏医生写道。

“It’s Chinese generic drugs that have bad quality,” he said.

“中国仿制药质量太差，”他写道。

In a statement on Friday, a unit of China’s National Medical Products Administration acknowledged the duplicated data, saying it was the result of “editing errors when the relevant product information was disclosed.”

中国国家药品监督管理局的一个部门在周五的一份声明中承认数据重复，并称这是“公开相关产品信息时，由于编辑错误”造成的。

The issue has hit a raw nerve when many people are feeling a sense of insecurity from China’s real estate downturn and sputtering consumer economy.

当许多人因中国房地产市场低迷、消费经济的乏力而感到不安全之际，这个问题触动了人们的敏感神经。

“If this isn’t a bottom line, I don’t know what is,” wrote Meng Chang, a journalist and host of a popular podcast, in a social media post that was later taken down.

“如果这不是底线，我不知道什么是底线，”记者、热门播客主持人孟常在一篇社交媒体帖子中写道，该帖子后来被删除。

“The vast majority of good doctors are in the public system,” Mr. Meng wrote. “But now, when you want to have imported drugs and surgery equipment, you have to go to the private sector.”

“绝大多数优秀医生都在公立医院，”孟常写道。“但现在，如果你想要进口药品和手术设备，就必须去私立医院。”

Most Chinese families see doctors in a hospital when they are sick. National medical insurance, which varies from province to province, typically covers, on average, nearly three quarters of the cost of any drug that is prescribed.

大多数的中国家庭在生病时都会去医院就诊。各省的医疗保险制度各不相同，但通常平均可以报销处方药费用的近四分之三。

On social media, some patients and doctors have said that the rise of generic brands in hospitals has made it difficult to even find original foreign branded drugs like Bayer’s Avelox antibiotic medicine.

在社交媒体上，一些患者和医生表示，医院中仿制药的增多使人们甚至很难找到像拜耳莫西沙星抗生素这样的原装进口药。

Li Xiang, a doctor from northeastern China, shared a story about how one of her family members needed an imported drug that was no longer available in public hospitals. But when she tried to contact a representative for the manufacturer, she was told the drug was out of stock.

来自东北的医生李香（音）讲述了一个故事，她的一个家人需要一种进口药，这种药在公立医院已经买不到了。但当她试图联系医药代表时，却被告知这种药已经缺货。

Dr. Li criticized the government’s procurement system, saying it resulted in an oversupply of drugs people do not want to use and too few alternatives.

李医生批评了政府的采购制度，称其导致人们不愿意使用的药物供应过剩，而替代品却太少。

“You say that medical insurance is running out and you can’t use it to buy imported medicines. I get that,” Dr. Li wrote. But, she added, she was willing to do anything, even sell her house, to secure the imported drug.

李医生写道：“你说医保快用完了，你没法用医保购买进口药了。我明白。”但她还说，为了买到进口药，她愿意做任何事情，甚至卖掉房子。

“I won’t risk switching to other substitutes for fear that the medicine won’t work and the condition will come back,” she wrote. “This involves the life of a family member.”

“我不会冒险换用其他药物，因为担心药物不起作用，病情会复发，”她写道。“这关系到家人的性命。”