Bibliometric Analysis of Drug Supply Chain in China

Cao Linlin,Wu Zhi’ang

(School of Business Administration,Shenyang Pharmaceutical University,Shenyang 110016,China)

Abstract Objective To study the development trend and hotspot of China’s drug supply chain in terms of bibliometrics to provide some reference for transforming and upgrading China’s pharmaceutical circulation industry.Methods Based on the data related to drug supply chain research from 1999 to 2019 collected by CNKI,Wanfang and VIP,software such as bibliographic information co-occurrence mining system (BICOMS) version 2.0,University of California Irvine Network (UCINET) version 6.0,and graphical clustering toolkit were used to measure and conduct visual analysis of the domestic drug supply chain research literature.Results and Conclusion Through literature analysis,it can be seen that the current research on drug supply chain in China mainly focuses on drug procurement and cost control,zero inventory control of hospital pharmacy,optimization and risk management of drug supply chain,and information of supply chain and logistics of pharmaceutical enterprises.Combining with the “Internet +” and other models,drug supply chain enterprise should optimize its management process according to the relevant national policy,promote information construction in all links of the supply chain,improve its transparency and ensure the quality and safety of drugs.The improvement of supply chain efficiency will enhance the transformation and upgrading of China’s pharmaceutical circulation industry.

Keywords:drug supply chain; bibliometrics; visual analysis; development trend

As the carrier of drug safety,the drug supply chain is also an important link to ensure drug safety.At the 18th National Congress of the Communist Party of China,the Party proposed a strategic plan for building a well-off society and deepening the reform and opening-up.Besides,with the continuous new medical reform,China’s pharmaceutical industry has been given new opportunities for development.As a result,the medical and health undertakings have developed rapidly,while the structure of the drug supply chain is changing.According to the “Statistical Analysis Report on the Operation of Pharmaceutical Distribution Industry in 2017” issued by the Ministry of Commerce of the People’s Republic of China,the size of pharmaceutical distribution market grew steadily in 2017.The total sales of the seven major categories of pharmaceutical products in China reached 201.6 billion yuan,and the retail drug market was 40.03 billion yuan.As for 2017,there were 13 146 pharmaceutical wholesale companies nationwide.There were 5 409 pharmaceutical retail chain companies with 229 224 retail stores.There were 224 514 retail single drug stores,and there was a total of 453 738 retail drug stores[1].According to the official website of the National Health Commission of the People’s Republic of China,by the end of August 2018,the number of medical and health institutions nationwide had reached 1.0 million,including 32 100 hospitals,949 500 primary medical and health institutions,19 700 professional public health institutions,and 20 700 other institutions[2].According to National Medical Products Administration’s“Annual Report on Food and Drug Administration Statistics for 2018”,at the end of November 2018,there were 4 441 enterprises producing crude drugs and preparations nationwide[3].According to the data on the official website of the Ministry of Commerce,the total sales of the seven major categories of pharmaceutical products in the first three quarters of 2019 were 1 724.7 billion yuan (including taxes),with a year-on-year growth of 8.78%.The growth rate was 1.44 percentage,excluding non-comparable factors.The retail market of pharmaceuticals was 344 9 billion yuan,a year-on-year growth of 9.97% and a growth rate of 1.06 percentage.Among them,the main income of pharmaceutical circulation direct reporting enterprises (1 054 enterprises) was 125.7 billion yuan(excluding tax),a year-on-year increase of 9.83%.This shows the scale of China’s pharmaceutical industry is very large.At the same time,as a special commodity,the supply chain of drugs is stricter than that of general commodities.Because there are numerous and complicated links in the drug supply chain.The low efficiency leads to the increasing cost and it is difficult to guarantee the drug quality and safety.Besides,the healthy development of the whole pharmaceutical industry will be restricted as well.

Research on the drug supply chain started quite late in China.In 2002,Chinese scholars introduced the concept of supply chain management into pharmaceutical industry[4].Since then,the literature on drug supply chain research has increased.Based on CNKI and other databases,bibliometrics was used to analyze the related research trends and hotspots of China’s drug supply chain literature so that some references could be provided for the research on drug supply chain in China.

1 Literature sources and research methods

1.1 Literature sources

In this paper,CNKI,Wanfang and Vip databases were used as index platforms.The search criteria were:(subject=supply chain and subject=medicine) or(subject=supply chain and subject=medicine) or(subject=supply chain and subject=medicine) (exact matching).Relevant literature on China’s drug supply chain research collected in each database from 1999 to 2019 was searched,and after removing duplicates and literature obviously inconsistent with the research topic,they were exported in a custom format.

1.2 Research methods and tools

Bibliometrics and visualization were used in this paper to conduct quantitative and clustering visual analysis of the content characteristics of domestic drug supply chain research literature with the help of bibliographic information co-occurrence mining system(BICOMS) version 2.0,University of California Irvine network (UCINET) vision 6.0,graphical clustering toolkit and gCLUTO.

2 Results and analysis

2.1 Bibliometrics

The databases of CNKI,WanFang and VIP were used to search the drug supply chain and related keyword pairs.The number of related literature was 1 146 on CNKI,2 323 on Wanfang,and 849 on VIP.According to the above criteria for inclusion and exclusion of documents,substandard documents were removed,and a total of 1 180 articles on the drug supply chain were retrieved.

2.1.1 Time distribution

The annual number of articles published in the related literature on China’s drug supply chain since 1999 was analyzed,as shown in Fig.1.In order to understand the domestic research progress of drug supply chain,the horizontal axis showed the time and the longitudinal axis means the number of documents.It can be seen from Fig.1,the number of the literature on the study of drug supply chain in China grew steadily after years of rising.The period from 1999 to 2019 showed a linear upward trend,which corresponded to the first introduction of the concept of supply chain management into the pharmaceutical industry by Chinese scholars in 2002.The quantity fluctuated slightly between 2009-2012 and 2014-2016.From the overall situation,it maintains a stable progress.

2.1.2 Periodical distribution

The retrieved documents were from 551 journals,which were widely distributed,indicating that the supply chain of pharmaceutical industry had been widely studied in China.Among the journals with more than 20 publications,59 were included inChina Drug Store,42 were included inChina Pharmacy,29 were included inLogistics & Material Handling,26 were included inLogistics Technology,24 were included inChina MarketandShanghai Medical &Pharmaceutical Journalrespectively,and 23 were included inChina Pharmaceuticals.

2.1.3 Distribution of authors and units

A total of 269 authors published two or more papers,which accounted for 31.95% of the total literature.19 people published more than five papers,including:Zhou Yutao with 11 papers,Dong Peng with 10 papers,Xu Guo and Hou Yanhong with 8 papers each,Zhao Jiao yun and Tang Shaoliang with 7 papers each,Yang Shujie with 6 papers,Feng Guozhong,Guo Shaolai,Gao Hongyu and Yang Yue published 5 papers each.Among them,Zhou Yutao and Dong Peng,who published a lot of articles,are all from universities engaged in the research of drug supply chain.

Units with a number of 10 or more papers included China Pharmaceutical University (82),Shenyang Pharmaceutical University (31),Shanghai Jiao Tong University and Nanjing University of Chinese Medicine (21 each),General Hospital of the People’s Liberation Army (Beijing 301 hospital)and Jiangsu Province Hospital (16 each),Huazhong University of Science and Technology (14),Renmin University of China (11),Nanjing Drum Tower Hospital (10).Generally speaking,most of the literature came from universities and hospitals,and few of them came from pharmaceutical enterprises,which may be related to the hot issue of drug reform in public hospitals under the background of new medical reform.

2.1.4 Statistics of high frequency keywords

BICOMB 2.0 was used to extract keywords.Due to various errors in the transformation and extracted data,data cleaning was required,such as the replacement of key field values for synonyms in keywords.The frequency threshold was set to 15,and 27 high-frequency keywords were obtained.Then they were sorted from high to low and the results were exported,as shown in Table 1.It can be seen from the high-frequency keywords in Table 1 that there are many researches on the drug supply chain in China,including supply chain,drug supply chain,supply chain management,drug,pharmaceutical industry,medicine logistics,medicine distribution and informatization,etc.

Table 1 Statistics of high frequency keywords

2.2 Analysis of network graph

In order to further confirm the research hotspot of drug supply chain in China,NetDraw in the software Ucinet was used to analyze the high-frequency word network.The main contents of the research field were analyzed by using the tightness of relationship between high frequency words.The high frequency keyword co-occurrence matrix generated by BICOMB 2.0 was first converted into a data file supported by NetDraw,and then imported into the file to generate the initial map of the high frequency word cooccurrence network.Based on this,the visualization analysis of centrality was carried out to obtain the graph of nodes in the network,as shown in Fig.2.The square represented the high frequency keyword node,and the larger the node is,the greater the role it plays in the network[5].

As can be seen from Fig.2,supply chain is the core of high frequency keywords,and this node is most closely related to other nodes.Secondly,there are supply chain management,drug supply chain,medicine logistics and drug circulation.These nodes also play an important role in the network and have strong connections with other high frequency words.The research contents of Chinese literature mainly focus on drug supply chain management,medicine logistics and the supply chain of circulation links.

2.3 Visual analysis of clustering

The lexicon matrix constructed by BICOMB 2.0 was imported into gCLUTO 1.0 for data clustering.According to relevant indexes,visual matrix diagram and visual hill diagram effect,the clustering was the best of 5 categories.Two visualization schemes can be obtained:visualization matrix and visualization hill.

The results of the double-clustering analysis of keyword lexical matrix are shown in Table 2.Cluster in the table was the cluster number and the size represented the volume of the mountain.Internal similarities (ISim) was the average similarity between objects in class.Internal standard deviation (ISdev)was the standard deviation of the mean similarity between objects in the class.External similarities(ESim) was the average similarity between classes.External standard deviation (ESdev) was the standard deviation of inter-class similarity.

Table 2 Keywords discourse matrix double cluster analysis results

2.3.1 Analysis of visual matrix diagram

The visual matrix diagram is shown in Fig.3.All visual schemes appeared below their corresponding clustering scheme.In Fig.3,the colors represented the values in the original data matrix.The row spacing class on the left represented the clustering of each keyword,the right represented the corresponding keywords of each cluster,the top meant the literature clustering,and the bottom represented the representative literature.The depth of color showed the frequency,in which colorless represented the value close to zero,and the darker the color,the greater the value was.

2.3.2 Analysis of visual hill map

The visualized hill is shown in Fig.4.The visualized hill diagram attempted to describe the interrelationships between groups from a threedimensional perspective.The visualized hill diagram was used to describe the number of clusters,relative similarity,intra-class similarity and intra-class standard deviation among the visualized groups.

2.3.3 Analysis of biclustering results

As shown in Fig.5,the row clustering result tree was obtained by stretching the visualization matrix graph in Fig.3.

(1) No.0.The color of hill No.0 is pale orange,the peak height is the highest,and the volume is the smallest.ISim is 0.329,indicating the highest similarity among objects in the class,the most concentrated topic distribution,and the least keywords.From the high frequency keywords zero inventory,cost control,drugs purchase and medical establishment,we could learn that the core content of this category was based on the cost control and zero inventory control of drug procurement by medical institutions.As an important part of the circulation of primary medicines,the procurement,storage,and the management of medicines at primary medical institutions are not only related to the daily safe use of medicines by the public,but also related to the reputation of medical institutions.Ren Hongfang[6]and Cao Yongmei[7]proposed to apply the cost control of procurement supply chain management to medical institutions,and they conducted a preliminary discussion on the main aspects of drug procurement application.Su Xiao[8-9]studied the cost control model based on the principal-agent theory and the information asymmetry theory of the drug supply chain,and proposed that hospitals should build a series of measures such as a drug transaction information system and standardize the centralized drug procurement process to effectively curb the increase of drug prices.Inventory control,as an important means for hospitals to reduce costs,is increasingly valued by hospital workers.Combined with the actual inventory situation in hospitals,Tang Yulin[10],Wang Jing[11],and Xu Shaodong[12]have improved stock of drugs by increasing the turnover rate of drugs in hospitals.This could cut costs for hospitals while increasing drug turnover and reducing the rate of drug wastage.Wu Dengfeng[13],Wang Jianlong[14],and Fu Hongpeng[15]respectively explored the drug inventory model,the information-based drug procurement model,and the drug bidding procurement Minhang model for the existing problems in drug procurement,and conducted feasibility analysis.

(2) No.1.The color of the peak of No.1 hill is green,the height of the peak is similar to that of No.3 mountain,and the size of the peak is larger.ISim is 0.227,indicating that there is a high similarity between objects in the class and the topic distribution is relatively concentrated.This topic focuses on the research on supply chain management of large pharmaceutical circulation enterprises such as chain drugstores in China’s pharmaceutical industry.This kind of literature mainly comes from pharmaceutical circulation enterprises,which is a change to the current situation of pharmaceutical circulation field.For example,Zhang Yubo[16],Chen Haiping[17]and Li Zhigang[18],by comparing the influences of drug prices,capital chains,drug manufacturers and circulation enterprises before and after the implementation of the two-ticket system,identified the impact of the deepening medical reform on the development trend of the drug circulation industry and provided relevant suggestions on transforming the drug circulation industry.Fan Linlin[19]and Wu Lei[20]compared the development status and related obstacles of chain drugstores at home and abroad through case data analysis,and pointed out that chain drugstores should be improved from the following aspects,such as strengthening the industry management and policy guidance,optimizing the supply chain management,expanding the operation scale of chain drugstores by means of merger or acquisition,and improving the pharmaceutical knowledge level and the quality of pharmaceutical care of the pharmacy staff.

(3) No.2.The color of the top of hill No.2 is blue,the height of the peak is slightly lower and the volume is small.ISim is 0.223,indicating that the similarity between objects in the class is normal.High frequency keywords mainly focus on essential drugs,medical equipments,supply chain,inventory control and hospital.Such literature mainly focuses on the inventory control of essential drugs and medical equipments in hospitals and related supply chains.These keywords are mainly related to the national requirements for hospitals to reduce the proportion of drugs in recent years,so the attention is higher.With the increasing importance of supply chain management in the supply of drugs and medical equipments,the idea of timely supply is applied from the perspective of hospital medical equipment supply.Chen Hui[21]believed that this theory would be beneficial to the safety and timeliness of hospital medical equipment supply.Yin Xiao[22]believed that the introduction of supply chain theory into the evaluation of basic drug supply guarantee would clearly and intuitively reveal the causal mechanism of policy effect,thus providing a more reasonable basis for policy formulation.Zhao Li[23]described essential drugs by using the power function demand,under the consideration of influence factors such as zero rate the sale,build the relevant essential drug supply chain profit distribution model for health care,and the method of using the shapely value to income distribution equilibrium results and numerical example inspection.Finally,it is concluded that health care instant settlement will help meet pharmaceutical enterprise interests and ease the contradiction between supply and demand of essential drugs.Liu Yudan[24]concluded through literature research that the establishment of an information platform for drug shortages could be handled in an emergency manner from the two aspects of production regulation and clinical use to reduce the occurrence of drug shortages.Bao Xuqian[25]believed that the construction of relevant medical equipment procurement decision-making platform based on the data of daily use and management of hospital medical equipments would help hospitals effectively manage materials,improve the utilization rate of equipment,reduce the failure rate of equipment and the occupancy of hospital funds.Therefore,it could better allocate medical equipment resources.

(4) No.3.The color of the peak of No.3 hill is light yellow.The height of the peak is high and the volume is relatively large.ISim is 0.227,indicating that this kind of theme has high similarity and many keywords.The main contents of the literature are information technology,pharmaceutical enterprise,logistics,drug safety.With the introduction of online sales of prescription drugs and other policies,the proportion of pharmaceutical e-commerce in pharmaceutical market will gradually increase,while the structure and mode of the traditional drug supply chain will change dramatically.Based on this background,pharmaceutical companies need to improve related logistics management while ensuring drug safety.Li Gelin[26,27]analyzed the optimization effect of pharmaceutical e-commerce model on China’s drug supply chain and its influence on the development of China’s pharmaceutical circulation industry,and proposed suggestions for further improving China’s pharmaceutical e-commerce.In terms of the risk management of drug supply chain,Mao Jinyang[28]analyzed the management of drug supply chain,comprehensively elaborated the existing problems,and put forward corresponding suggestions based on the risk management and control of supply chain.Guo Yanan[29]used time-driven activity-based costing(ABC) to conduct logistics cost accounting modeling for bio-pharmaceutical enterprises on the basis of logistics cost,and verified the effectiveness and feasibility of time-driven ABC in logistics cost accounting of bio-pharmaceutical enterprises through an example.In terms of the optimization and integration of drug supply chain,Di Rong[30],Ruan Luning[31],Zhao Yue[32],Han Shengxi[33]and Dong Yuhua[34]all pointed out the problems and drawbacks of China’s drug supply chain,clarified the necessity of optimization and integration of China’s drug supply chain,and proposed corresponding strategies respectively.

(5) No.4.The color of the peak of No.4 hill is red,the peak height is the lowest,but the volume is large.ISim is 0.221,indicating that there is low similarity among objects in the class,the topic is scattered,and the number of keywords is the largest.The topic of this kind of literature is informatization of supply chain and logistics of pharmaceutical enterprises.Informatization has always been one of the hotspots of supply chain management research.For pharmaceutical industry,the complexity of its own business determines the importance of informatization of its industrial supply chain management[35].For instance,after comparing the three patterns of the current hospital drug supply chain,Kou Jianqiu[36]believed the hospital with the third party cooperation mode of supply chain could achieve the optimal benefit in cost,efficiency and quality management.Therefore,the hospital information system system should further expound the deployment and implementation method of this model from the aspects of the management strategy,system architecture and security.Tian Shoulin[37]believed that pharmaceutical companies should meet hospital needs of formulating logistics extension service plans,assisting in developing hospital drug logistics information management system,and realizing the automatic control of hospital drug logistics facilities.Meanwhile,the whole-process of cold chain management of drugs can be realized through the project of radio frequency Internet.

3 Discussions and conclusions

By reviewing and analyzing the literature about China’s drug supply chain collected from CNKI and other databases,the trends and hotspots of China’s drug supply chain research can be found.

According to the literature,research on drug supply chain in China is still in the preliminary stage of exploration.At present,the focus of literature research is about drug procurement and cost control,zero inventory control of hospital drug storehouse,optimization and risk management of drug supply chain,informatization of supply chain and logistics of pharmaceutical enterprises.However,studies from the global perspective of drug supply chain are scarce.The overall research is not comprehensive,and most of them are qualitative discussions without empirical analysis.Particularly,there is no research on successful supply chain management of local benchmark enterprises,leading to the absence of referred supply chain management mode for the development of pharmaceutical enterprises[38].

As to literature authors and sources,most of the literatures come from universities and hospitals.Compared with medical institutions,drug production and drug distribution enterprises are important links in drug supply chain with rich experience in supply chain management.Therefore,it is suggested that pharmaceutical enterprises should increase their manpower and capital investment in supply chain research and strengthen effective communication with other enterprises to realize the sharing of supply chain resources.The “Drug Administration Law”amended in 2019 explicitly required:“drug listing license holders,drug manufacturers,drug distributors and medical institutions shall establish and implement a drug traceability system,provide traceability information in accordance with regulations for drug safety.” At the same time,this version of the “Drug Administration Law” fully included the most severe penalties for enterprises if they don’t follow the rules throughout the whole process.Under the background of zero drug markup implemented by public medical institutions nationwide in 2017 and the centralized drug purchase implemented by the state in the past two years,medical institutions were required to control the cost to the maximum extent,which makes it vital to reduce the circulation and storage cost through the intelligence of drug supply chain.The reform of drug supply chain industry can be carried out from the following aspects.First,in order to accelerate the construction of informatization,drug supply chain companies can establish a perfect information system to realize the visual management of the whole logistics management,so as to guarantee the quality of drugs,and the whole logistics process can be traced.Secondly,the supply chain should be integrated to build new logistics based on the Internet.The use of automatic machinery should be increased in the storage process to save costs,improve the efficiency and the security of drug storage from the warehousing,sorting,distribution stage.According to the current situation,hospital logistics service should reform to reduce the storage of drugs and improve the supply of medical equipments,so as to realize the intelligent management as soon as possible.

To sum up,with the increasing number of literature and the gradual deepening of the study,the research results of China’s drug supply chain have great reference value and social benefits,but it still needs to broaden the field from theory to practice,from qualitative to quantitative.With the continuous improvement of policies,the progress of technology,and the gradual establishment of standards,China’s drug supply chain needs innovation and transformation in the context of “Internet +” and medical reform.Therefore,it can form the Internetbased drug supply chain with sharing information and win-win cooperation.Enterprises should take the responsibility for drug safety,better promote the optimization and integration of drug supply chain,and ensure the quality of drugs in the whole process.