Procurement in German office based ambulatory physician practices: system specific challenges and evidence based management strategies

Abstract

Procurement is an important managerial function in healthcare, influencing supply continuity, process stability, and quality assurance. While hospital procurement has been studied extensively, evidence on procurement structures in German ambulatory care remains limited and conceptually fragmented. In particular, office based physician practices, group practices, medical care centers, outpatient hospital departments, and physician networks are often discussed under the same umbrella term, although these organizational forms differ substantially in governance, scale, and purchasing capacity. This narrative, concept driven review focuses specifically on office based ambulatory physician practices in Germany, with particular attention to small group practices in urban primary care settings. The available literature indicates that direct peer reviewed evidence quantifying procurement specific cost shares in this sector remains scarce. International physician practice economics further suggests that procurement related savings alone are unlikely to generate large absolute efficiency gains across all ambulatory settings. Procurement should therefore be understood not only as a cost factor, but also as a managerial field affecting supply reliability, workflow continuity, coordination, and resilience. Compared with hospitals, office based ambulatory practices are characterized by smaller purchasing volumes, limited economies of scale, fragmented supplier relationships, and restricted administrative capacity. Instruments such as ABC VED analyses, Kanban based replenishment, periodic stock review, and structured supplier arrangements may support procurement management in these settings. The proposed model should be interpreted as a practice oriented framework rather than as an intervention with proven large scale cost effects. Abs1