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As drug expenditures continue to rise, healthcare systems face growing pressure to improve procurement efficiency and control supply costs. Using game theory, this study identifies optimal procurement strategies for each stakeholder in the pharmaceutical supply chain, depending on market size, discount levels, and the group purchasing organisation’s (GPO) bargaining power. Specifically, medical institutions tend to engage in group procurement to aggregate demand in smaller markets, while in larger markets, they favour diversified strategies to maintain sourcing flexibility. The pharmaceutical manufacturer is more likely to adopt low-discount group procurement in both small and large markets, but shifts towards diversified procurement under medium or high discounts to maximise profits. A further comparison between decentralised and group procurement, with the manufacturer remaining the leader and the decision sequence unchanged, shows that medical institutions benefit more from group procurement as discounts strengthen. However, the manufacturer benefits only when demand expansion and economies of scale offset price concessions. Moreover, GPO bargaining power emerges as a pivotal factor that can alter the game’s dynamics, with its relative strength or weakness even capable of reversing the strategic choices of both buyers and suppliers. Managerial implications for medical institutions and pharmaceutical manufacturers regarding their procurement strategy are discussed.
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Wu et al. (2026) studied this question.
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