——从湖北精神病院骗保案，看一个拒绝透明的治理逻辑

作者：李聪玲

编辑：张致君 校对：程筱筱 翻译：戈冰

近年来，中国社会频繁出现一些令人不安却高度相似的场景：未成年人在校园中“非正常死亡”，调查迅速定性；普通人被送进精神病院，出院却难如登天；家属提出质疑，随即被纳入“维稳”对象；信息被封锁，讨论被压制，结论被提前写好。这些经历并非彼此孤立的“个案”，而是高度集权体制在现实运行中，对普通人进行系统性碾压的结果。

新京报近期披露的湖北多家精神病医院骗保调查，正是这一治理逻辑的一个极端却典型的缩影。据新京报调查报道，湖北襄阳、宜昌多家精神病医院，以“免费住院、医药费和生活费全免”为诱饵，违规收治大量并无明显精神障碍的人员，涉嫌通过虚构诊疗项目、伪造病历，系统性套取医保资金。

2025年12月，记者以护工身份卧底进入襄阳宏安精神病医院、宜昌夷陵康宁精神病医院，发现住院者中不仅包括戒酒者、行动不便的老年人，甚至连护工、保安本人，也被办理成“精神病人”住院手续，只为配合医院完成医保报销流程。医生直言，只要“能走医保”，病历是可以“写”的。在这些医院中，将正常人“写成精神病”并非偶发失误，而是一种高度制度化的操作方式。记者查询收费系统发现，大量账目中反复出现“心理治疗”“行为矫正”等收费项目，但无论是记者本人还是其他病人，均未见相关治疗实际开展。仅这些虚构项目，日均费用约130元。一名护工私下透露：“一个病人一年能套六万，一百个就是六百万。”

为了规避监管，有医院在检查前安排病人“假出院”，检查结束后再重新收治，形成事实上的长期滞留。住院人数越多、住院时间越长，医院获取的医保资金就越多，而病人则被彻底物化为维持医院运转的“指标”。多名病人反映，入院极其容易，出院却几乎不可能。即便病情好转，甚至本就不存在精神疾病，也常被以各种理由强行留院。记者卧底期间，多次目睹医护人员对病人实施暴力：扇耳光、脚踹、用水管抽打，甚至将病人捆绑在床上，最长达三天三夜。有病人形容，“住院就像坐牢”，有人因长期无法出院而陷入绝望，甚至发生自杀行为。

这些医院多位于偏远地区，运营成本低、扩张速度快，通过下乡拉人、介绍提成等方式争抢“病源”。在医保结算机制与监管缺位的双重作用下，一套以剥夺人身自由、践踏人格尊严为代价的牟利模式，得以长期存在。必须指出的是，湖北精神病医院骗保与非法收治现象，并不能被简单归因为“地方乱象”。其真正的危险性，在于它暴露的并非个别道德沦丧，而是一整套制度性激励失衡所催生的必然结果。

在现行医保体系中，精神病院具有特殊优势：诊断标准高度依赖专业判断，外部难以复核；住院周期缺乏明确上限；病人往往被视为“无完全行为能力者”，其拒绝权与申诉权在现实操作中极易被忽视。一旦监管缺位，医疗机构便天然拥有“低风险、高回报”的操作空间。同时，医保支付机制对“住院人数”和“住院时长”形成客观激励。在缺乏独立审计与透明问责的情况下，这种激励并不会自动导向更好的医疗服务，反而容易异化为对“病人数量”的追逐。湖北曝光的“虚构诊疗”“假出院”“长期滞留”，正是这一逻辑的直接产物。更值得警惕的是，被违规收治者往往是最缺乏反抗能力的人群：老年人、残障人士、戒酒者、社会边缘人。一旦被贴上“精神异常”的标签，其个人陈述与社会信用便迅速贬值，侵害人身自由反而披上了“医学”“照护”“稳定”的外衣。

从校园中被迅速定性的未成年人死亡，到精神病院中被随意书写的“精神异常”，这些事件看似不同，实则遵循着同一治理逻辑：当一个人的存在被视为“风险”，而不是权利主体，他就会被制度性地处理掉。在这一逻辑下，死亡不再首先被追问真相，而被纳入舆情管控；诊断不再是医学问题，而成为控制工具；家属的合理质疑被重新定义为“不稳定因素”。当“维稳”凌驾于真相之上，当“效率”高于人的尊严，制度本身便开始系统性地制造受害者。

湖北多家精神病医院骗保事件真正令人不寒而栗的，并不只是暴力与贪婪，而是它揭示了一个现实：在一个缺乏独立监督的体制中，最弱势的人，最容易被合法地伤害。当正常人可以被写成精神病，当孩子的死亡可以不经独立调查便被迅速结案，当公共制度不再服务于人的安全，而是服务于权力的便利，那么任何人，都无法确信自己不会成为下一个“被处理对象”。问题从来不在某一家医院、某一个地方、某一次事件，而在于一个拒绝透明、排斥问责、惩罚追问的治理体系。只要这一结构不被改变，类似的悲剧就不会停止，只会不断更换场景、对象与说辞。

一个正常的社会，不需要靠封锁信息来维持秩序；一个负责任的政府，也不需要通过剥夺人的尊严来证明稳定。真正的安全，来自真相被允许出现，来自权力被置于监督之下，来自每一个生命被当作目的，而不是手段。

People Diagnosed by the System

—The Hubei Psychiatric Hospital Insurance Fraud Case Reveals a Governance Logic That Resists Transparency

Abstract: The Hubei psychiatric hospital insurance fraud case exposes how, under a system lacking transparency and accountability, diagnosis has been distorted into a tool of control. Vulnerable groups face legal deprivation of freedom and dignity, while so-called “stability” comes at the cost of creating victims—reflecting a systemic governance crisis.

Author: Li Congling

Editor: Zhang Zhijun Proofreader: Cheng Xiaoxiao Translator: Ge Bing

In recent years, Chinese society has witnessed a disturbing pattern of strikingly similar scenarios: minors suffering “abnormal deaths” on school campuses, with investigations swiftly concluding their causes; ordinary citizens being committed to psychiatric hospitals, only to face insurmountable hurdles upon discharge; families raising questions immediately becoming targets of “stability maintenance”; Information is blocked, discussions suppressed, and conclusions predetermined. These experiences are not isolated “individual cases,” but rather the result of systematic oppression of ordinary people within the highly centralized system’s practical operations.

The recent investigation by The Beijing News into multiple psychiatric hospitals in Hubei Province defrauding medical insurance funds serves as an extreme yet typical microcosm of this governance logic. According to the newspaper’s investigative report, several psychiatric hospitals in Xiangyang and Yichang, Hubei, used “free hospitalization, medication, and living expenses” as bait to illegally admit large numbers of individuals without obvious mental disorders. They are suspected of systematically siphoning medical insurance funds by fabricating treatment plans and falsifying medical records.

In December 2025, reporters posing as nursing assistants infiltrated Xiangyang Hong’an Psychiatric Hospital and Yichang Yiling Kangning Psychiatric Hospital. They discovered that among the hospitalized patients were not only individuals undergoing alcohol rehabilitation and elderly people with mobility issues, but even nursing assistants and security guards themselves had been registered as “psychiatric patients” solely to facilitate the hospitals’ medical insurance reimbursement processes. Doctors openly admitted that medical records could be “written” as long as they “qualify for insurance coverage.” In these hospitals, classifying healthy individuals as “psychiatric patients” was not an isolated error but a highly institutionalized practice. A review of billing systems revealed repeated charges for “psychological therapy” and “behavioral correction” across numerous accounts. However, neither the reporter nor other patients observed any actual implementation of such treatments. These fabricated charges alone amounted to approximately 130 yuan per day. One caregiver privately disclosed: “One patient can generate 60,000 yuan annually; a hundred patients mean 6 million yuan.”

To evade oversight, some hospitals arrange “fake discharges” before inspections, only to readmit patients afterward, effectively creating prolonged stays. The more patients hospitalized and the longer their stays, the more medical insurance funds the hospital receives—reducing patients to mere “metrics” sustaining hospital operations. Multiple patients reported that admission was extremely easy, while discharge was nearly impossible. Even when their condition improved, or they had no mental illness to begin with, they were often forcibly retained under various pretexts. During the undercover investigation, the reporter repeatedly witnessed medical staff using violence against patients: slapping, kicking, beating with water hoses, and even restraining patients to beds for up to three days and nights. One patient described hospitalization as “like being in prison.” Some, trapped indefinitely, succumbed to despair and even attempted suicide.

These hospitals, predominantly located in remote areas, operate with low costs and rapid expansion. They aggressively recruit patients through rural outreach and referral commissions. Amidst gaps in medical insurance settlement mechanisms and oversight, a profit model built on depriving individuals of their freedom and trampling on their dignity has persisted. It must be emphasized that the insurance fraud and illegal admissions at Hubei psychiatric hospitals cannot be simplistically dismissed as “local chaos.” Their true danger lies not in isolated moral failures, but in exposing the inevitable outcome of systemic incentive imbalances.

Within the current medical insurance system, psychiatric hospitals hold unique advantages: diagnostic criteria heavily rely on professional judgment, making external verification difficult; inpatient stays lack clear upper limits; and patients are often deemed “legally incompetent,” with their rights to refuse treatment and file complaints frequently overlooked in practice. When oversight is absent, medical institutions inherently gain “low-risk, high-return” operational leeway. Simultaneously, the medical insurance payment mechanism creates objective incentives for “hospitalization numbers” and “length of stay.” Without independent audits and transparent accountability, these incentives do not automatically lead to better medical services but instead easily degenerate into a pursuit of “patient volume.” The exposed practices in Hubei—fictitious diagnoses, fake discharges, and prolonged detentions—are direct products of this logic. More alarmingly, those admitted under irregularities are often the most vulnerable: the elderly, disabled individuals, alcoholics in recovery, and marginalized members of society. Once labeled as “mentally abnormal,” their personal accounts and social credibility rapidly devalue, while infringements on personal liberty are cloaked in the guise of “medical care,” “support,” and “stability.”

From minors swiftly categorized in schools to arbitrary “mental abnormality” diagnoses in psychiatric hospitals, these seemingly disparate incidents follow the same governance logic: when an individual’s existence is viewed as a “risk” rather than a rights-bearing subject, they become subject to systemic disposal. Under this logic, death is no longer primarily investigated for truth but incorporated into public opinion control; diagnosis ceases to be a medical issue and becomes a tool of control; and families’ legitimate doubts are redefined as “unstable factors.” When “maintaining stability” overrides truth-seeking, and “efficiency” trumps human dignity, the system itself begins to systematically create victims.

What is truly chilling about the insurance fraud incidents at multiple psychiatric hospitals in Hubei is not merely the violence and greed, but the reality they expose: within a system lacking independent oversight, the most vulnerable are most easily harmed with impunity. When sane individuals can be labeled mentally ill, when a child’s death is swiftly dismissed without independent investigation, when public systems serve not human safety but the convenience of power—no one can be certain they won’t become the next “target for disposal.” The problem never lies in a single hospital, location, or incident, but in a governance system that rejects transparency, shuns accountability, and punishes inquiry. As long as this structure remains unchanged, similar tragedies will not cease. They will only change their settings, subjects, and justifications.

A normal society does not need to maintain order by blocking information; a responsible government does not need to prove stability by stripping people of their dignity. True security comes from allowing truth to emerge, from placing power under oversight, and from treating every life as an end in itself, not a means to an end.