Restrictions to Pharmacy Ownership and Vertical Integration in Estonia—Perception of Different Stakeholders

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Abstract

Objectives: From 2020, the ownership of community pharmacies in Estonia will be limited to the pharmacy profession, and the vertical integration of wholesale companies and community pharmacies will not be allowed. The aim of this study was to evaluate the perception of different stakeholders in primary healthcare toward the new regulations of the community pharmacy sector in Estonia. Methods: A qualitative electronic survey was distributed to the main stakeholders in primary healthcare and higher education institutions providing pharmacy education ( n = 40) in May 2015. For data analysis, the systematic text condensation method was used. Results: The study participants described two opposing positions regarding the development of community pharmacies in the future. Reform supporters emphasized increased professional independence and more healthcare-oriented operation of community pharmacies. Reform opponents argued against these ideas as community pharmacists do not have sufficient practical experience and finances to ensure sustainable development of the community pharmacy sector in Estonia. Conclusion: Based on the current perception of all respondents, the future operation of the community pharmacy sector in Estonia is unclear and there is urgent need for implementation criteria for the new regulations.

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Most cited references 18

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Estonia: health system review.

Taavi Lai, Triin Habicht, Kristiina Kahur … (2013)

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.

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Impact of regulation of Community Pharmacies on efficiency, access and equity. Evidence from the UK and Spain.

María Lluch, Panos Kanavos (2010)

In this paper, we focus on regulatory restrictions on Community Pharmacies and whether these have an impact on efficiency, access and equity and thus in the delivery of services community pharmacists provide to patients. Primary data collection through semi-structured interviews and secondary data collection through literature review have been used with a particular focus on Spain (a country where Community Pharmacy is strictly regulated) and the UK (a country where Community Pharmacy is considered liberalised by EU standards). The findings indicate that improved pharmacy operational efficiency is the result of appropriate incentive structures, ownership liberalisation and OTC price freedom as is the case in the UK. Equity and access seem to be better achieved by establishing geographic, demographic or needs-based criteria to open new pharmacies (as is the case in Spain). In sum, there are useful lessons for both countries: the UK could look into the policies applied in Spain that increase access and equity whilst Spain could adopt some of the policies from the UK to increase efficiency in the system. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

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Change in public satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005.

Daisy Volmer, J. Bell, Riina Janno … (2009)

The health care systems of Estonia and other Baltic States underwent major reforms between restoration of independence from the USSR and admittance to the European Union. These reforms included changes to the regulations regarding the ownership, location, and number of community pharmacies. The objective of this study was to analyze changes in access to, image of, and satisfaction with community pharmacy services in Tartu, Estonia, between 1993 and 2005. A survey instrument was mailed to a stratified random sample of 713 Estonians aged 20-69 years living in Tartu in 1993 and again to 1000 Estonians aged 20-69 years living in Tartu in 2005. Completed survey instruments were returned by 448 (63%) respondents in 1993 and 386 (39%) respondents in 2005. Respondents in 2005 reported more frequent visits to pharmacies than respondents in 1993 (P=.012) and were more likely to indicate that pharmacies have more appropriate locations and opening hours (P<.001). In 2005, 71% of respondents reported always visiting the same pharmacy compared to 35% in 1993. The perceived trustworthiness of pharmacists remained constant. Respondents believed that the role of the pharmacist as a provider of drug information should be expanded; however, demand for extended community pharmacy services was low. Postindependence reforms to health care and pharmacy systems in Estonia have coincided with greater utilization of community pharmacy services. Higher rates of utilization and continued good standing within the community suggest that pharmacies are potentially well placed to make additional contributions to the evolving primary health care system in Estonia.

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Author and article information

Contributors

Janine M. Traulsen: Role: Academic Editor

Journal

Journal ID (nlm-ta): Pharmacy (Basel)

Journal ID (iso-abbrev): Pharmacy (Basel)

Journal ID (publisher-id): pharmacy

Title: Pharmacy

Publisher: MDPI

ISSN (Electronic): 2226-4787

Publication date (Electronic): 19 April 2016

Publication date Collection: June 2016

Volume: 4

Issue: 2

Electronic Location Identifier: 18

Affiliations

Institute of Pharmacy, Faculty of Medicine, University of Tartu, 1 Nooruse Str, Tartu 50411, Estonia; marit.gross@ 123456ut.ee

Author notes

[* ]Correspondence: daisy.volmer@ 123456ut.ee ; Tel.: +372-7-375-298; Fax: +372-7-375-289

[†]

These authors contributed equally to this work.

Article

Publisher ID: pharmacy-04-00018

DOI: 10.3390/pharmacy4020018

PMC ID: 5419345

SO-VID: ed33f4ca-6ee6-46a4-9614-67b14ab01cfc

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

History

Date received : 30 October 2015

Date accepted : 12 April 2016

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