Excessive profit

Moreover, experts say that heart stents are over-priced. A domestic heart stent normally costs more than 9,000 yuan, while an imported one can cost about 17,000 yuan. Some doctors kick up to 25 percent of heart stents costs to their department directors, and some doctors can earn 2,000 yuan by doing the operation for a hospital that lacks qualified staff, the Beijing News reported. By US standards, these figures might seem low, but for China's relatively poorly paid doctors they represent significant earnings.

For instance, a 4-millimeter-long blood clot can be dealt with a 4-millimeter-long stent, but some doctors use a 2-millimeter-long stent and a 3-millimeter-long stent because the two put together are more expensive. The Beijing News cited a former medical sales representative, surnamed Zhou, as saying. "Not only medical sales representatives but also hospitals prefer these doctors who can make money in heart stents operation."

Some sales representatives give 45 percent of the sales price to hospitals and doctors as a broker's fee, the Oriental Outlook reported.

The sales process of heart stents is quite complicated as it needs to go through different level agents and hospitals, the Beijing-based Legal Weekly reported, which further drives up the price.

"The price of heart stents increases by about 2 percent through each agent in the process [When the heart stents are sold to patients], the price could be eight or nine times when it left the factory," said Wang Lei, an agent.

Counter-measures

China's health authority has taken measures to stop the overuse of heart stents, with the central government issuing a notice in 2013 requiring bulk government purchasing of pricey medical consumable materials, including heart stents, in order to reduce prices.

There are no regulations on how many heart stents can be implanted, and many doctors noted that chaotic management and lax supervision are responsible to the overuse, Xinhua reported.

According to a document issued by the former Ministry of Health in 2011, the hospital needs to conduct a group consultation if a doctor wants to implant more than three heart stents.

The Heilongjiang provincial health authority has requested hospitals report operation plans to implant more than three heart stents to medical quality control authority in an effort to curb over treatment, the Beijing News reported.

However, the document was not enforced in many hospitals, Xinhua reported.

Zhong said that the government should supervise clinical practice. Hu echoed Zhong, saying that mechanisms should be established to evaluate doctors' choices so that healthcare insurance providers can refuse to pay for an unnecessary operation.

Hu added that doctors who implant overpriced stents or conduct unnecessary operations should be punished.