Changes in the Swedish pharmacy market
Short description
The Swedish pharmacy market is changing and actors other than the state-owned Apoteket AB have obtained the right to retail sales of drugs to the consumer. We study how the market is reconstructed, how pharmacists act as institutional entrepreneurs and how the practice is reshaped. Which players will dominate the market is an open question.
Aim of the project
The overarching aim of the project has been to study the complexity characterizing the pharmacy market, as well as the development of organisations and professional groups, and how norms change and stabilize.
We have fulfilled this aim by describing and analysing the development of the pharmacy market, e.g. how relations between new and old actors are formed and which norms take precedence, on the basis of a constructivist perspective on markets. The empirical findings from parts of the study have contributed towards shifting our original analytical focus away from institutional entrepreneurship to institutional logics. By means of ethnographically-inspired methods, we have also studied how market practices are emerging, how different actors' interests are being expressed, and how work at pharmacies is being shaped and organised.
The most important findings of the project
1. Practice and the position of the profession
There is a lengthy tradition in the pharmacies of combining practices based on, on the one hand, a professional medical logic and, on the other, a logic that builds on sales and markets. Re-regulation has contributed towards clarifying these differences and, in certain cases, bringing them to a head, e.g. with regard to the supervision of over-the-counter medicines in the retail trade.
There is historical variation in who is allowed to own/run/work at pharmacies which is also of interest from an international perspective. In our comparisons between the US, the UK, and Italy, we see that there is a clear trend whereby the ownership of pharmacies is moving towards ever larger chains led by a "general manager" rather than a pharmacist. The actors' competence thus has to encompass not just pharmaceutical expertise but also, for instance, marketing, finances, legal aspects, something that is also reflected in other requirements concerning parts of the university education in pharmaceutics.
2. Construction of the market
The pharmacy market is "framed" to a great degree by procedures and techniques that are checked by government actors, e.g. pricing and the use of e-prescriptions. Such procedures contribute towards creating and clarifying boundaries between different actors, e.g. patient, pharmacist, prescriber, supplier. This boundary-creation is a prerequisite for these boundaries to also be able to be exceeded, and a functional market practice created.
The market is also "framed" by different types of regulations and provisions (e.g. concerning price, stock-keeping, confidentiality, safety) which partly limit minor actors on the market, but which also affect the management of over-the-counter medicines in the retail trade. The different ways in which the market is "framed" contribute towards both including and excluding actors.
3. Actors and relationships
The study shows that, in times of change, previously established boundaries between actors and professions can be challenged.
Pharmacists (and other professional groups working at pharmacies) can be described in terms of being "in-between" in several respects:
- they act "in-between" private financiers and owners, on the one hand, and laws, regulations and control systems, on the other.
- they also act "in-between" private interests where the confidentiality of individuals is crucial simultaneous to the existence of a public interest in documentation and statistics concerning the use of pharmaceuticals.
- some pharmacists also act "in-between" pharmaceutical and medical competence, as well as more market and management-wise competencies.