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Diversity as salvation?: A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (Samhällsfarmaci)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0002-3921-5522
Köpenhamns universitet.ORCID iD: 0000-0001-5848-8625
2019 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 123, no 5, p. 457-461Article in journal (Refereed) Published
Abstract [en]

Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009–2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition–a goal–while in other cases it was seen as a condition to be met in order to achieve competition–a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity.

Place, publisher, year, edition, pages
2019. Vol. 123, no 5, p. 457-461
Keywords [en]
Community pharmacy, Community health care, Regulations, Liberalization, Sweden, Diversity
National Category
Pharmaceutical Sciences
Research subject
Social Pharmacy
Identifiers
URN: urn:nbn:se:uu:diva-380072DOI: 10.1016/j.healthpol.2019.03.005ISI: 000468719700003PubMedID: 30890380OAI: oai:DiVA.org:uu-380072DiVA, id: diva2:1298501
Available from: 2019-03-23 Created: 2019-03-23 Last updated: 2019-06-24Bibliographically approved
In thesis
1. The Liberalization Experiment: Understanding the political rationales leading to change in pharmacy policy
Open this publication in new window or tab >>The Liberalization Experiment: Understanding the political rationales leading to change in pharmacy policy
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In 2009, a pharmacy policy reform was introduced in Sweden whereby the state owned community pharmacy monopoly was abolished. As a result two thirds of the pharmacies were sold. As there were no longer restrictions on ownership and establishment, new pharmacies and new owners appeared. The overall aim of this thesis is to contribute to a more nuanced understanding of the stated and the underlying rationales for the reform, specifically, to understand how key stakeholders view the reform, and the future role of the community pharmacy. Document analysis was the method used to study the preparatory work, plenary debates, and interviews with stakeholders from political, professional and patient organizations.

The government directive stated that the reform would lead to improvement of availability and efficiency, a pressure on prices and a better use of medicines.  However, the results show that during the reforms’ preparatory phase, the rationales changed and only availability remained throughout the process. Diversity on the market was added later as a rationale. The effects of the reform were perceived in similar ways by the different stakeholder groups. The views on the reform was more negative after the reform.

Interviewees who were previously in favor of the reform were surprised that diversity had not been achieved; that the counseling in the pharmacies had deteriorated and that the availability of medicines decreased after the reform. Interviewees from political organizations had a more business-oriented view of pharmacies/ists, while participants from professional organizations had a more healthcare-oriented perspective.

Finally, this thesis studied the diversity rationale behind the pharmacy reform and compared it to the primary care reform. The results show that, in both cases, policy makers definitions of diversity were vague and unclear, which appear to have complicated their implementation.

Since the pharmacy reform neglected to investigate alternative means of achieving the goals/rationales, it can be argued that the reform was ideologically based and had a preconceived understanding as to how the community pharmacy sector should be regulated. There are several reasons for drawing this conclusion: the reform was launched despite the original rationales being considered as impossible to fulfill, and, except for abolishing the monopoly on state-owned pharmacies, the stakeholders did not seem to know what the reform would lead to, except increasing the number of pharmacies. The latter could have been achieved without the reform as the government had control over the state-owned pharmacy monopoly.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 55
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 268
Keywords
pharmacy policy, reregulation, liberalization, Sweden, pharmacist, pharmacy
National Category
Medical and Health Sciences
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-380096 (URN)978-91-513-0609-4 (ISBN)
Public defence
2019-05-17, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2019-04-24 Created: 2019-03-24 Last updated: 2019-06-18

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