Digitalization and Deep Structural Change: Is the Platformization of the Healthcare Sector Inevitable?

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Digitalization is believed to deeply affect all sectors of society. A particularly interesting sector in this regard is pharmaceutical distribution. Its deep institutional structure has evolved over centuries and has shaped healthcare systems in all Western societies. At its core lies the institutional separation of the professions of pharmacists and physicians. The current wave of digital technologies has led to the so-called platformization of various industries, including the healthcare sector. Platforms are currently being built which offer medical consultation and drug delivery as a ‘one-stop-shop’ and, to support such integration of pharmaceutical and medical services, the abolishment of the ‘historical separation’ of the professions of pharmacists and physicians has been called for. European history is replete with challenges to this deep institutional structure of the healthcare sector which, so far, have been fended off. This sector is therefore particularly interesting for the study of digital transformation of society as a whole since it provides a ‘critical case’. Studying the way in which it has responded to challenges in the wake of societal disruption in the past and in the present will therefore provide clues to the underlying mechanisms and dynamics of societal transformation, including the present such period driven by the arrival of a new generation of digital technologies. This project will study three periods in which the organization of pharmaceutical distribution has experienced significant change. In the first period (1800-1850), a joint practice of pharmacist and physician to formulate complex medicines has reached a climax, within the boundaries of the institutional separation of the two professions. In the second period (1910-1938) health insurance organizations became a proto-form of modern platforms in that they contracted pharmacists and physicians, imposed strict restrictions on drugs to be prescribed and dispensed, and negotiated prices with pharmacists. This resulted in the complete separation of the two professions in the sense that the joint practice of formulating medicines was lost. In the third, the current period (2010-2025), the possibility has arisen again to develop a joint practice that brings the two practices of pharmacists and physicians closer together again, this time focusing on medication as such. Increasingly, the safety of medication becomes a major public health issue and managing medication therapies is seen as a way to improve and optimize medication therapies. Will pharmacists and physicians once again learn to cooperate within the boundaries of the institutional separation of pharmacists and physicians or will platforms succeed in overthrowing this separation in order to employ big data analytical techniques to centrally oversee and optimize medication therapies?