Integrity risks in the management of medical consumables in Chinese public hospitals: a PESTEL-based qualitative policy analysis

This study systematically examines integrity risks in the management of medical consumables in Chinese public hospitals. Drawing on policy documents, a review of the literature, and expert discussions, the study applies the PESTEL framework to identify six macroenvironmental risk factors across its various dimensions. It further synthesizes three risk-transmission mechanisms, institutional gaps, distorted incentives, and information concealment, to explain how macroenvironmental factors may create integrity vulnerabilities in hospital operations. Based on this analysis, five governance strategies are proposed: establishing cross-departmental coordination mechanisms, optimizing compensation systems, promoting transparent collaboration among industry, academia, and research institutions, advancing digital procurement, and implementing multidimensional oversight. Each strategy directly addresses the identified transmission mechanisms while accounting for its feasibility in Chinese public hospital settings. The findings suggest that integrity risk governance requires a systematic, multidimensional approach and a shift from ex post sanctions to proactive risk prevention. 1. A PESTEL-based analytical framework reveals six dimensions of integrity risks in medical consumables management within Chinese public hospitals—Political fragmentation, Economic dual pressures, Social asymmetry, Technological deficits, Environmental classification ambiguity, and Legal enforcement gaps—each with distinct causal pathways to corrupt practices. 2.Three risk transmission mechanisms—institutional gaps, incentive distortions, and information opacity—are inductively identified from expert consultations, explaining how macro-environmental factors translate into integrity vulnerabilities and providing a theoretical bridge between structural diagnosis and intervention design. 3. A closed-loop governance logic—from diagnosis to strategy—is operationalized: five targeted interventions (cross-departmental coordination, remuneration restructuring, industry–medicine collaboration, information-based traceability, and standard-setting) are proposed to address specific PESTEL risk factors and their underlying transmission pathways. 4. The Chinese experience offers a distinctive case of health system reform and carries implications for other developing health systems undergoing similar transitions.