Pharmacy Regulation in Sweden. A New Institutional Economic Perspective

Sammanfattning: The aim of this thesis is to analyze and to explain the institutional change in the provision of pharmaceuticals in Sweden. The thesis’ contribution is studies of this specific institutional development. New Institutional Economic theory is used to scrutinize the driving forces of this development. The thesis consist of three papers. The purpose of the first paper is to discuss and to analyze the historical roots of the set of rules and regulations, a development which mainly took place during the 17th century. Central issues are: how these regulations were carried out and what factors had an influence on how these regulations were designed. The conclusion of the analysis is that the regulations were carried out through arrangements, such as the creation of a hierarchy within the health organization, a pharmacopeia, education and inspections. The set of regulation studied is regarded as a creation of a contracting process between parties and was mainly influenced by three factors, the bargaining power of the contracting parties, influences from the area that today is Germany and the guild system. The objective of the second paper is to describe and analyze the change in organization of pharmacies in Sweden that took place during the first decades of the 20th century. The principal question in this paper is why a process of collectivization occurred during the first decades of the 20th century. The focus of this study is on the ideas behind the process rather than the process itself. Three major factors had a significant impact on the institutional change; centralized and uniform prices, the demand for public access to pharmacies as well as a low public acceptance to wide profit range. A solution, with these prerequisites, was the creation of an internal profit fund. The third study compares Sweden and Denmark, and focuses the role played by the choice of regulatory system in the 1900s in terms of the number of pharmacies and prices of pharmaceuticals. The main difference between Swedish and Danish regulatory systems was the Swedish goal of equalisation of pharmacists’ incomes. The number of pharmacies expanded more in Sweden compared to Denmark, especially during the period after World War II. This could partly be explained by differences in the benefit system and geographical factors, but also by differences in the regulatory system, especially in the period after 1970. Pharmaceutical prices became more expensive in Denmark relative to Sweden during the studied period. The development of pharmaceutical prices is, however, a very complex issue, making it difficult to isolate the impact of a regulatory system.