A question of emphasis: efficiency or equality in the provision of pharmaceuticals

The reported results are part of the overall evaluation of the new drug distribution legislation that went into effect in March 1996, liberalising ownership of community pharmacies in Iceland. We addressed the following question: What impact did the legislation have on users' access to and costs of pharmaceuticals? Seven focus group discussions were conducted with pharmacy customers in different locations in May, August and October 1997. Widespread ignorance about the legislation was observed. Pharmacy customers preferred to discuss the role of physicians in 'irrational drug use' to discussing community pharmacies. A definite split was observed between urban and rural pharmacy customers; whereas definite changes were reported in the urban setting (lower prices and increased access), the rural population's perception is that it is being left out. Although the study design is not generalisable, it is clear that the equilibrium between equality and efficiency in pharmaceutical distribution in Iceland has shifted. The introduction of the free market system has increased inequality between rural and urban residents in exchange for increased efficiency.