{
  "abstract": "Background:: While the overall impact of pooled drug procurement on drug procurement has been evaluated, little is known about how healthcare institutions’ pre-policy procurement composition is associated with heterogeneous post-policy procurement responses. This study addresses this gap under China’s National Volume-Based Procurement (NVBP) policy.\n\nMethods:: We used monthly procurement data from January 2018 to December 2020 from four provinces in China, covering both pre- and post-policy periods, as the NVBP policy was implemented in January 2020. Outcomes were procurement volumes, measured as the number of defined daily doses (DDDs), of NVBP-covered drugs (bid-winning and non-winning products) and their clinically substitutable alternatives. All healthcare institutions in the selected provinces were included and stratified by (1) their pre-policy share of bid-winning products among NVBP drugs and (2) their pre-policy share of NVBP drugs among both NVBP and alternative drugs, to assess institutional heterogeneity. Interrupted time series (ITS) analysis was conducted to assess the immediate (level) and long-term (slope) post-policy changes.\n\nResults:: Procurement volumes of bid-winning products increased substantially following the policy (level change: 1275%, P<.01), with smaller increases observed among healthcare institutions with higher pre-policy bid-winning shares (eg, highest-share subgroup: 441%, P<.01), consistent with uniform procurement targets. Although overall procurement of alternative drugs remained stable, healthcare institutions with higher pre-policy NVBP shares experienced significant increases, with level changes of up to 1010.9%, suggesting substitution driven by financial losses. In contrast, healthcare institutions with lower NVBP shares saw notable declines (level change: −34.8% to −65.2%), possibly reflecting demand-side substitution toward lower-priced NVBP drugs.\n\nConclusion:: Findings highlight that in pooled procurement, procurement behaviour is shaped more by regulatory enforcement and financial incentives than by price-driven demand. Strengthening guidance and oversight of supplier behaviour remains essential to realizing the full benefits of pooled procurement reforms.",
  "abstract_shown": true,
  "affiliations": [
    "School of Public Health, Peking University, Beijing, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Boya Zhao",
      "orcid": "0009-0001-2017-7802"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhao Cheng",
      "orcid": "0009-0004-0616-0897"
    },
    {
      "affs": [
        0
      ],
      "name": "Xing Lin Feng",
      "orcid": "0000-0003-3588-1859"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c8dbxjs8eqcf1.bib",
  "cited_by": 0,
  "doi": "10.34172/ijhpm.9372",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13729802/",
  "id": "c8dbxjs8eqcf1",
  "issns": [
    "2322-5939"
  ],
  "landing_url": "https://doi.org/10.34172/ijhpm.9372",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2002|Pharmaceutical Economics and Policy"
    ]
  ],
  "openalex": "W7168080941",
  "pdf_url": "https://www.ijhpm.com/article_4877_b71155d90aef3bc38cb92db5a9afe4ce.pdf",
  "pmcid": "PMC13729802",
  "pmid": null,
  "published": "2026-06-07",
  "publisher": "Kerman University of Medical Sciences",
  "ris": "https://research.draconitic.com/paper/c8dbxjs8eqcf1.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:22:32Z",
      "native_id": "PMC13729802",
      "source": "pmc",
      "url": "https://doi.org/10.34172/ijhpm.9372"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2739|Healthcare Systems and Reforms",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Understanding Heterogeneous Drug Procurement Behaviour of Healthcare Institutions Under Pooled Procurement: Evidence From China",
  "title_text": "Understanding Heterogeneous Drug Procurement Behaviour of Healthcare Institutions Under Pooled Procurement: Evidence From China",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:32Z",
  "url": "https://research.draconitic.com/paper/c8dbxjs8eqcf1",
  "venue": "International Journal of Health Policy and Management",
  "versions": []
}