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Reregulation of the Swedish pharmacy sector: A qualitative content analysis of the political rationale
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
2015 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, no 5, p. 648-653Article in journal (Refereed) Published
Abstract [en]

In 2009, a reregulation of the Swedish pharmacy sector took place, and a fundamental change in ownership and structure followed. The reregulation provides an opportunity to reveal the politicians' views on pharmacies. The aim of thiS study was to explore and analyze the political arguments for the reregulation of the Swedish pharmacy sector in 2009. The method used was a qualitative content analysis of written political documents regarding the reregulation. The primary rationales for the reregulation were better availability, efficiency, price pressure, and safe usage of medicines. During the preparatory work, the rationales of diversity on the market and entrepreneurship were added, while the original rationales of efficiency, price pressure, and better usage of medicines were abandoned. The reform can be seen as a typical New Public Management reform influenced by the notion that private actors are better equipped to perform public activities. The results point to that the reform was done almost solely in order to introduce private ownership in the pharmacy sector, and was not initiated in order to solve any general problems, or to enhance patient outcomes of medicine use.

Place, publisher, year, edition, pages
2015. Vol. 119, no 5, p. 648-653
Keywords [en]
Pharmacy policy, Regulation, Community pharmacy, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-256851DOI: 10.1016/j.healthpol.2015.03.009ISI: 000355031900011PubMedID: 25841749OAI: oai:DiVA.org:uu-256851DiVA, id: diva2:827345
Available from: 2015-06-26 Created: 2015-06-26 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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Wisell, KristinWinblad, Ulrika

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