LI Xin, CHEN Xi, DU Zhong
Accepted: 2026-09-09
Incorporating designated retail pharmacies into the outpatient pooling scheme is a critical part of the reform of the employee medical insurance system. This policy allows patients to obtain reimbursement for prescription drugs purchased at designated retail pharmacies, with the reimbursement rate aligned with that of primary healthcare institutions. Based on a pharmaceutical supply chain comprising a retail pharmacy, a hospital, and a drug supplier, this paper develops generalized Nash bargaining models, compares profits, consumer surplus, and social welfare under three scenarios: non-participation in the outpatient pooling scheme, participation in the outpatient pooling scheme without centralized procurement, and participation in both the outpatient pooling scheme and centralized procurement. Based on these comparisons, we derive the pharmacy’s optimal strategy from the perspectives of pharmacy profit, consumer surplus, and social welfare. The findings reveal that from the perspective of pharmacy profit, the pharmacy prefers to participate in the outpatient pooling scheme without centralized procurement only when its market share, additional unit operational cost, and price coefficient are all relatively large. From the perspective of consumer surplus, the pharmacy prefers to participate in both the outpatient pooling scheme and centralized procurement only when it has a relatively large market share and a relatively low operational cost. From the perspective of social welfare, the pharmacy prefers to participate in both the outpatient pooling scheme and centralized procurement only when the reimbursement rate or the price coefficient is relatively large. Regardless of whether pharmacy profit, consumer surplus, or social welfare is considered, non-participation in the outpatient pooling scheme is never the optimal strategy for the pharmacy. Furthermore, the equilibrium outcomes and their relative rankings across the three scenarios are jointly determined by the reimbursement rate, bargaining power, price coefficient, operational cost, and market share. The findings provide decision references for pharmacies’ operational model choice and offer theoretical references for improving their operational performance.