Analysis and Solutions for Drug Shortages in Multi-level Medical Institutions in China: References for Developing Countries

Background In China, the growth of medical demand has put multi-level medical institutions in a dilemma of drug shortages, which affects medical services and patients' access to medical treatment. This study focuses on China, aiming to analyze the current situation, causes, and impacts of drug shortages, so as to provide a basis for optimizing the pharmaceutical supply chain and improving the drug shortage early warning mechanism,it also provides references for other developing countries, facilitating the balanced allocation of global medical resources. Methods Based on 1,272 pieces of data on drugs in short supply from 109 medical institutions across China between January 2023 and December 2024, descriptive statistical methods were employed. The data were classified and summarized according to the institutional levels (tertiary, secondary, primary and Ungraded) and pharmacological categories (11 categories). The analysis was carried out from three aspects: the number of reported cases, the distribution of product specifications, and the causes of shortages. The data sorting and verification were independently completed by two researchers, and statistical analysis was conducted using Microsoft Excel. Results Key findings include: (1) Tertiary hospitals reported the highest number of shortages (52.67%), with cardiovascular drugs (31.45%) being the most affected category, particularly furosemide injection (12.19%) and phenobarbital injection (10.77%); (2) The primary causes of shortages were "other reasons" (28.4%), production halts/reduced capacity (22.1%), and price-related issues (26.9%), with significant variations across institution levels (e.g., "other reasons" accounted for 32.5% in unclassified institutions); (3) Critical shortages were observed in emergency medications (e.g., nikethamide injection) and low-cost generics (e.g., allopurinol tablets). Conclusion Drug shortages result from the interplay of market failure, supply chain vulnerabilities, and policy limitations, necessitating a multi-dimensional intervention framework. This study provides data support and practical approaches for the governance of nationwide drug shortages, and holds reference significance for improving the national drug guarantee system.