Group Purchasing Organizations, Health Care Costs, and Drug Shortages
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U.S. Government Accountability Office
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An empirical analysis of aftermarket transactions by hospitals.
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Automating Procurement Contracts in the Healthcare Supply Chain Using Blockchain Smart Contracts
Omar, I. A., Jayaraman, R., Debe, M. S., Salah, K., Yaqoob, I., & Omar, M. (2021) · IEEE Access · doi:10.1109/access.2021.3062471 · Cited by 259 · see citing works
“Hence, healthcare providers usually reach out to large buying groups such as Group Purchasing Organizations (GPO) to improve their HCSC by gaining collective pricing power, and procurement efficiency [4], [5].”
BackgroundDillard‐Wright, J., Hopkins‐Walsh, J., & Brown, B. B. (2020) · Advances in Nursing Science · doi:10.1097/ans.0000000000000313 · Cited by 59 · see citing works
Organizational Governance of Emerging Technologies: AI Adoption in Healthcare
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“formulary, health systems work with external group purchasing organizations to negotiate rates with the manufacturer and supply the device [5].”
BackgroundComparative Approaches to Drug Pricing
Kang, S., Bai, G., DiStefano, M. J., Socal, M. P., Yehia, F., & Anderson, G. F. (2019) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040119-094305 · Cited by 44 · see citing works
Early Financial Impact of the COVID-19 Pandemic on U.S. Hospitals
Li, K., Al‐Amin, M., & Rosko, M. D. (2023) · Journal of Healthcare Management · doi:10.1097/jhm-d-22-00175 · Cited by 35 · see citing works
Shortages and price variability of essential cytotoxic medicines for treating children with cancers
Martei, Y. M., Iwamoto, K., Barr, R. D., Wiernkowski, J. T., & Robertson, J. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-003282 · Cited by 28 · see citing works
“56 The limited sample size may misrepresent the true access to chemotherapy in individual countries but may be accurate for LMICs where there are few paediatric cancer centres.”
Shortages of medicines in OECD countries
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“Additionally, limited evidence suggests that the charging practices of some GPO suppliers have led to problems in the supply chain and shortages of some drugs [34].”
BackgroundSupply Chains in Healthcare Organizations: Lessons Learned from Recent Shortages
Emmett, D. C. (2019) · Hospital Topics · doi:10.1080/00185868.2019.1644264 · Cited by 17 · see citing works
“In addition, the four largest GPOS accounted for 90 of the market for medical supplies (Bruhn, Fracica, and Makary, 2018).”
BackgroundLi, X., & Xu, J. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1392239 · Cited by 17 · see citing works
“This approach is widely adopted in the global public drug procurement, as evidenced by studies conducted by (Weinstein, 2006; Hu and Schwarz, 2011; Zhou et al., 2017; Bruhn et al., 2018).”
MethodShortages of essential cancer medicines: who is responsible and what are the possible solutions?
Jenei, K., Lythgoe, M. P., & Vokinger, K. N. (2024) · The Lancet Oncology · doi:10.1016/s1470-2045(23)00470-9 · Cited by 12 · see citing works
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Management of a parenteral opioid shortage using ASHP guidelines
Vo, P., Sylvia, D. A., Milibari, L., Stackhouse, J. R., Szumita, P. M., Rocchio, M. A., Cotugno, M. C., Belisle, C., Morris, C. A., Goralnick, E., et al. (2021) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxaa425 · Cited by 5 · see citing works
Hemel, D. J., & Ouellette, L. L. (2023) · Entrepreneurship and Innovation Policy and the Economy · doi:10.1086/723235 · Cited by 5 · see citing works
“For example, mostmedical centers acquire drugs through group purchasing organizations (GPOs), which act as intermediaries between purchasers and manufacturers (Bruhn, Fracica, and Makary 2018).”
BackgroundDean, E. B., Pierre, R., Carter, S., & Bond, A. M. (2024) · Health Affairs Scholar · doi:10.1093/haschl/qxae067 · Cited by 4 · see citing works
“7,8 The use of bundled contracts—contracts with deeper discounts when a hospital purchases multiple products from a single manufacturer—is also controversial.”
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Key Drivers and Mitigation Strategies of Oncology Drug Shortages 2023 to 2025
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Health System Purchasing Professionals’ Approaches to Considering Equity in Procurement
Hauschildt, K. E., Bernstein, T., Crews, D. C., Drabo, E. F., Ferryman, K., Jackson, J. W., Valley, T. S., Levy, J., & Iwashyna, T. J. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.12.016 · Cited by 3 · see citing works
An activist history of drug shortages and its silos
Duffin, J. M. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31876-6 · Cited by 3 · see citing works
U.S. Health Care in the Trump Era: A Data Update
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Secured Transactions in Healthcare supply Chain using Blockchain
Muthusundari, S., Nischal, S., Sathyanarayanan, S., & Sharath Lingam., S. (2024) · International Conference on Pervasive Computing and Social Networking (ICPCSN) · doi:10.1109/icpcsn62568.2024.00105 · Cited by 1 · see citing works
The value of group purchasing: Evidence from the U.S. hospital industry
Lin, H., & Wang, Y. (2025) · Journal of Public Economics · doi:10.1016/j.jpubeco.2025.105380 · Cited by 1 · see citing works
Noteworthy Literature in 2018 for Cardiovascular Anesthesiologists and Intensivists
Flynn, B. C., Shen, L., Littlejohn, J., Shirak, M. O., & Ivascu, N. S. (2019) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/1089253219842659 · Cited by 1 · see citing works
Group Purchasing Organizations and Costs—Reply
Bruhn, W. E., Fracica, E. A., & Makary, M. A. (2019) · JAMA · doi:10.1001/jama.2019.1103 · Cited by 1 · see citing works
Self-citationGroup Purchasing Organizations and Costs
Ebert, T. (2019) · JAMA · doi:10.1001/jama.2019.1099 · Cited by 1 · see citing works
Getting Ours? “Girlbossing” and the Ethics of Nurse Reimbursement Models
Jenkins, D., Cohen, J., Walker, R., McMurray, P., & Wright, J. D. (2024) · Health Equity · doi:10.1089/heq.2024.0059 · Cited by 1 · see citing works
Ensuring availability of respiratory medicines in times of European drug shortages
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Hospital use of group purchasing organizations: A cost effect analysis
Jisan, A. H., Castel, M. J., & Nicolae, M. (2025) · International Journal of Healthcare Management · doi:10.1080/20479700.2025.2496985
“With their higher purchasing volumes, larger GPOs have greater negotiating power with vendors, thus enhancing their value proposition for member hospitals [23].”
Gaelen, J. I., Sarver, A., Holverscheid, A., Shaffer, J., Leavitt, O. S., & Cheon, E. C. (2025) · Anesthesiology · doi:10.1097/aln.0000000000005632
An algorithmic approach to pharmacoeconomic analyses
Sadalagi, S. M., H., H. K. K., & Dr Kishore, S. (2025) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20254168
Pharmaceutical PricingPreprint
Liu, Q., Yu, S., Wen, S., & Cai, Y. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6367218
Deep-Dive into the Mapping of Decision-Related Problems
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Exploring How Demand and Supply Knowledge Can Improve Centralized Public Health Procurement
Boyer, E. J., Cusumano, N., Olmedo, C., & Vecchi, V. (2026) · The American Review of Public Administration · doi:10.1177/02750740261464911
“Given that more than 90% of private healthcare supplies are purchased through intermediaries called group purchasing organizations (GPOs) (Bruhn et al., 2018), the lessons presented here inform related studies of hospital interactions and supply market intelligence on hospital purchasing rates from…”
Lellouche, F., Brochard, L. J., Ricard, J.-D., Goodfellow, L. T., & Branson, R. D. (2026) · CHEST Critical Care · doi:10.1016/j.chstcc.2026.100306
- Authors
- Bruhn, W. E., Fracica, E. A., & Makary, M. A.
- Affiliations
- Johns Hopkins University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-11-13
- Volume
- 320
- Issue
- 18
- Pages
- 1859
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2896926508
- Cited by
- 37
- References
- 2
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 6
- FWCI
- 5.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Business, Management and Accounting › Management Information Systems › Supply Chain and Inventory Management
- Keywords
- group purchasing organizations, health care costs, drug shortages, drug supply, health care cost containment
- MeSH terms
- Pharmaceutical Preparations, Economic Competition, Health Facility Merger, United States, Drug Costs, Health Care Costs, Group Purchasing
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