????中國有句俗話：“常在河邊走，哪有不濕鞋。”意思是說在一個腐敗的文化里很難獨善其身。近日，西方制藥巨頭葛蘭素史克（GlaxoSmithKline）被中國政府指控涉嫌在中國進行大范圍行賄，看來它也一頭掉進了臟水里。

????當然，現階段我們聽到的只是一面之辭，也就是中國警方對葛蘭素史克的指控。所以目前最好謹慎看待這件事，不宜早下定論。不過這起指控還是給想在中國這個快速增長的消費市場分一杯羹的西方跨國企業提出了兩個重要的挑戰。首先是在中國這樣一個潛規則盛行、反市場政府政策屢見不鮮以及本地企業習慣性搞小動作甚至直接拉攏腐蝕的環境里，西方企業應該怎樣生存。其次是一旦你在中國取得成功，占據了大量市場份額后，怎樣才能規避中國的保護主義措施。

????對于第一個問題，葛蘭素走運的地方就在于選擇了一個正確的生意上，因為中國對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融資模式功能失調的醫藥體系里混飯吃，而在這個體系里，好人也會被迫變成壞人。從數字上看，中國的醫藥市場市值目前大概在4,000億美元左右，而到2020年，這個市場的規模將達到10,000億，是任何一個西方制藥企業都不能忽視的市場。2012年，中國市場的藥品銷量達到820億美元，其中包括約100億美元的進口藥品。西方制藥企業以及1,500多家合資公司通過進口和合資生產等方式在中國市場上攫取了巨大的市場份額。在大多數大城市里，他們的銷量占總銷量的比重高達60%至65%。

????不幸的是，西方制藥企業也必須忍受中國醫藥行業的黑暗面。中國政府為醫藥行業選擇了一種世界上獨一無二的融資模式，通過高藥價來補貼醫療。公立醫院一般有三大收入來源：政府撥款、醫療服務、賣藥。政府撥款只占中國公立醫院預算的10%。為了讓老百姓看得起病，政府把醫療服務的價格定得很低。醫院要提供這些服務，就注定要賠錢。為了使醫院運轉得下去，中國政府允許醫院高價賣處方藥。結果來自賣藥的收入一般會占城市公立醫院收入的40%到50%，在農村，這個比例還要高得多。

????這種融資模式通過藥價推高了老百姓的醫療成本，同時鼓勵了腐敗。為了在這個有利可圖的市場上搶一塊蛋糕，很多制藥企業都通過賄賂醫生來讓他們給病人開自家公司的處方藥。根據中方的指控，葛蘭素史克通過“召開”不存在的會議，替醫生報銷根本不存在的“差旅費”，可見葛蘭素史克也走了邪路，而且顯然遭到了更嚴格的處理。

????之前，葛蘭素史克已經有過幾次行賄史了，所以似乎不值得同情。不過由于中國社會的腐敗無處不在，加上中國醫療行業的融資模式如此不合理，在現實逼迫下，葛蘭素史克以及其他西方制藥企業可能毫無選擇的余地，只能被迫混水摸魚——除非他們決定遠離中國這個蓬勃發展的醫療市場。

????"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.