To evaluate the effects of China’s centralized drug procurement policy and provide references for the healthy development of the pharmaceutical industry and policy optimization.

A framework was constructed based on policy instrument theory. Content analysis was used to quantify 27 national-level policy documents from 2000 to 2024, and fuzzy-set qualitative comparative analysis (fsQCA) was applied to conduct configuration analysis of 21 typical cases.

The structure of policy instruments was imbalanced, with environmental instruments accounting for 46.69%, while demand-type instruments constituted only 26.03%. Five core necessary conditions (consistency>0.9) were identified: drug procurement,procurement behavior regulation, drug price adjustment, industry standards, and drug regulation, with consistency scores of 0.966, 0.934, 1.000, 0.963, and 0.948, respectively. Two configuration paths were distilled: a regulation-core-driven path and a comprehensive safeguard path characterized by multi-instrument synergy.

An optimization framework of"institutional rigidity-dynamic adaptation" is proposed. Recommendations include optimizing the structure of policy instruments, promoting synergy between regulation and the market, and improving incentive mechanisms to advance the continuous refinement of centralized drug procurement policies.