Keywords
Pharmaceutical Procurement
Procurement Models
Hospital Purchasing
Payment Reforms
Bundled Payments
Health Financing
Public Hospitals
Abstract
Background. Rising surgical expenditures challenge the financial sustainability of public health systems. Pharmaceutical procurement is an important component of surgical care, but procurement choices are shaped by financing, governance, pricing policy, and provider-payment incentives. This scoping reviews mapped pharmaceutical procurement strategies used in public hospital surgical care and examined how health system architecture and payment reforms influence their design and implementation.
Methods. We conducted a scoping review following PRISMA-ScR and a prospectively registered protocol. PubMed, Scopus, and Web of Science were searched for English-language literature published from 1 January 2018 through 31 December 2025 using a Population-Concept-Context framework. Forty-three sources were included after duplicate removal, title/abstract screening, and full-text assessment. Procurement mechanisms, pricing and reimbursement levers, provider-payment arrangements, health system context, and reported outcomes were charted and synthesized narratively.
Results. Two broad and overlapping patterns were identified. Centralized and pooled procurement approaches, including national or regional tendering and group purchasing, remain the dominant mechanisms for obtaining price and volume advantages. Value-oriented procurement is less mature and is typically enabled by broader payment reforms rather than functioning as a payment model itself. In particular, bundled and episode-based payments can shift hospital incentives from minimizing pharmaceutical acquisition prices toward managing total episode cost and outcomes. The evidence base is concentrated in high-income settings, and direct evidence linking bundled payment to selection of surgical pharmaceuticals remains limited.
Conclusion. Strategic pharmaceutical procurement is context-dependent and should be aligned with health system governance, pharmaceutical pricing policy, and provider-payment incentives. The evidence supports an adaptive approach in which high-volume, substitutable products are suited to competitive or pooled procurement, whereas higher-cost or outcome-sensitive products may require value assessment, negotiated agreements, and stronger clinical-data infrastructure. These conclusions should be interpreted cautiously because the evidence is heterogeneous and predominantly descriptive.
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