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Stakeholders’ expectations and perceived effects of the pharmacy ownership liberalization reform in Sweden: a qualitative interview study
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.
Univ Copenhagen, Dept Pharm, Univ Pk 2, DK-2100 Copenhagen O, Denmark.
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, article id 379Article in journal (Refereed) Published
Abstract [en]

Background: Reforms in the health-care sector, including the pharmacy sector, can have different rationales. The Swedish pharmacies were prior to 2009 organized in a state-owned monopoly. In 2009, a liberalization of the ownership took place, in which a majority of the pharmacies were sold to private owners. The rationales for this liberalization changed profoundly during the preparatory work, making it probable that other rationales than the ones first expressed existed. The aim of this study was to explore the underlying rationales (not stated in official documents) for the liberalization in the Swedish pharmacy sector, and also to compare the expectations with the perceived outcomes.

Methods: Semi-structured interviews were conducted with representatives from key stakeholder organizations; i.e., political, patient, and professional organizations. The analysis was performed in steps, and themes were developed in an inductive manner.

Results: One expectation among the political organization participants was that the ownership liberalization would create opportunities for ideas. The competition introduced in the market was supposed to lead to a more diversified pharmacy sector. After the liberalization, the participants in favor of the liberalization were surprised that the pharmacies were so similar.

Among the professional organization participants, one important rationale for the liberalization was to get better use of the pharmacists’ knowledge. However, all the professional, and some of the patient organization participants, thought that the counseling in the pharmacies had deteriorated after the liberalization.

As expected in the interviews, the post-liberalization pharmacy sector consists of more pharmacies. However, an unexpected perceived effect of the liberalization was, among participants from all the stakeholder groups, less access to prescription medicines in the pharmacies.

Conclusions: This study showed that the political organization participants had an ideological basis for their opinion. The political stakeholders did not have a clear view about what the liberalization should lead to, apart from abolishing the monopoly. The perceived effects are quite similar in the different stakeholder groups, and not as positive as were expected.

Place, publisher, year, edition, pages
2016. Vol. 16, article id 379
Keywords [en]
community pharamcy, regulation, pharmacy policy, Sweden
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
URN: urn:nbn:se:uu:diva-301433DOI: 10.1186/s12913-016-1637-6ISI: 000381258500001PubMedID: 27519573OAI: oai:DiVA.org:uu-301433DiVA, id: diva2:954632
Projects
The monopoly experimentAvailable from: 2016-08-23 Created: 2016-08-23 Last updated: 2019-03-24Bibliographically 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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