An ideological playground? Changes in community pharmacy ownership - a case study from four Nordic and Baltic countries.

The pharmacy systems have undergone fundamental changes in some Nordic and Baltic countries: Iceland, Norway, Sweden and Estonia. The political declared aims of the reforms have included increasing competition and/or effectiveness of the pharmacy market and the availability of medicines or pharmacies. The aim of this commentary is to describe the policy measures taken in these countries changing community pharmacy ownership, the arguments and rationales behind, and the evidence of the intended and unintended outcomes. Furthermore, we discuss the lessons learned for social pharmacy researchers. The aim of increasing the availability of pharmacies has been achieved, if interpreted as more pharmacies. However, the number of pharmacies has increased, mainly in urban areas, with a need to assure the availability of pharmacies in rural areas with regulations and/or subsidies in some countries. There were also unintended consequences. The aim to increase competition and diversity failed, as big domestic and foreign pharmacy chains conquered most of the pharmacy market. Learning for researchers in social pharmacy when studying pharmacy system changes includes considering the social, economic, and political reality in which the sector exists. The intended and unintended consequences of changes need a multi-method approach, often mixing quantitative (epidemiology and economics) and qualitative social science methods. Lastly, if we want evidence-based policymaking, we as researchers need to do better in communicating our research evidence to politicians and to the public.