The Liberalization Experiment : Understanding the political rationales leading to change in pharmacy policy

Sammanfattning: 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.