title: Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries.
abstract: OBJECTIVE
  To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs.
  
  
  METHODS
  We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews.
  
  
  RESULTS
  Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy.
  
  
  CONCLUSIONS
  Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist.
authors: WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2). Electronic address: sabine.vogler@goeg.at.
authors: Sabine
authors: S
authors: Vogler
authors: WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2). Electronic address: katharina.habimana@goeg.at.
authors: Katharina
authors: K
authors: Habimana
authors: WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Stubenring 6, 1010 Vienna, Austria(2); Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, 28359 Bremen, Germany. Electronic address: danielle-arts@hotmail.com.
authors: Danielle
authors: D
authors: Arts
mesh_terms: D003132:Commerce; D003157:Community Pharmacy Services / Q000331:legislation & jurisprudence / Q000592:standards; D003365:Costs and Cost Analysis; D005060:Europe; D005252:Fees, Pharmaceutical / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D006297:Health Services Accessibility; D004366:Nonprescription Drugs / Q000191:economics / Q000627:therapeutic use; D010594:Pharmacies / Q000191:economics / Q000331:legislation & jurisprudence* / Q000592:standards; D011795:Surveys and Questionnaires
chemical_list: D004366:Nonprescription Drugs
keywords: Community pharmacy; Deregulation; Europe; Policy change