Reforming the white coat economy: judicial evidence and institutional implications from China’s healthcare anti-corruption campaign

Objective This study aimed to construct a reproducible sample of judicially visible healthcare corruption in China, identify its typologies, risk nodes, actor structures, and elucidate the institutional mechanisms underlying representative cases. Methods An explanatory sequential mixed-methods design was used. Criminal judgments with dates from 1 September 2019 to 31 December 2025 were retrieved from China Judgments Online in January 2026 and screened, yielding 573 judgments involving 787 defendants. Phase 1 used structured coding for descriptive analysis, while phase 2 used embedded multiple-case analysis of purposively selected, information-rich cases to explain key institutional mechanisms. Results Cases clustered into three main categories, namely pharmaceutical/clinical commercial bribery (267, 46.60%), embezzlement of in-hospital funds (137, 23.91%), and medical insurance fund fraud (99, 17.28%). Risk points concentrated on procurement (335 cases), medical insurance auditing/payment (136 cases), and in-hospital finance/asset management (122 cases). Among defendants sentenced to imprisonment ( n = 710), the median principal penalty was 36 months, probation was 42.90%, fines was 91.70%, and recovery/disgorgement/forfeiture was 84.81%. Cross-case analysis revealed that corruption hinged on the coupling of gatekeeping authority, supplier inducement, professional discretion, and control over payment or accounting interfaces. Conclusion Publicly available criminal judgments provide a reproducible risk map of judicially visible healthcare corruption in China. Findings support node-oriented governance prioritizing procurement transparency, payment-side auditing, and high-risk internal posts. These data should be interpreted as legally filtered governance evidence rather than as direct estimates of underlying corruption incidence.