'A smile is most important.' Why chains are not currently the answer to quality concerns in the Indian retail pharmacy sector
'A smile is most important.' Why chains are not currently the answer to quality concerns in the Indian retail pharmacy sector
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DOI：
10.1016/j.socscimed.2018.07.001
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发表时间：
2018-09-01
影响因子：
5.4
通讯作者：
Goodman, Catherine
中科院分区：
文献类型：
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作者：
Miller, Rosalind;Hutchinson, Eleanor;Goodman, Catherine
连锁药店在许多中低收入国家(LMIC)正在扩大。从历史上看，独立药房在这些环境中的做法一直很差，需要了解这些新的组织安排如何影响药房的运作，以及对公共卫生的影响。借鉴经济学文献，我们就连锁店如何解决典型的LMIC零售药房市场的质量问题提出了一系列假设，并通过2014至2015年间在印度孟加卢市进行的38次深度访谈来探索这些假设。我们具体考察了连锁企业如何影响几种关键行为：聘用合格员工；政府当局将监管重点放在中央管理结构上的能力；企业自我监管的倾向；以及连锁企业员工与独立所有者相比可能面临的权力较弱的激励的影响。在实践中，连锁组织和独立组织在这些领域几乎没有区别。并不是所有的连锁店都有合格的药剂师(类似于独立商店)。药品管制当局没有利用现有的连锁架构来执行监管。连锁店确实进行了严格的自我监管，但他们的重点是客户服务，而不是与健康结果相关的质量方面。此外，该部门普遍存在的贿赂行为是有效药物管制的障碍。最后，由于奖励销售目标和增加销售的压力，连锁店员工面临的激励措施并不低效。我们观察到，连锁店对其工作人员产生了强大的影响，但利用这一点来提高护理质量的潜力目前尚未实现。如果没有财政激励或加强外部监管，就不太可能将重点从顾客满意转向公共卫生关切的结果。
Chain pharmacies are expanding in many low and middle-income countries (LMICs). Historically practices of independent pharmacies in these settings have been poor, and there is a need to understand how these new organisational arrangements are affecting the functioning of pharmacies, and the implications for public health. Drawing on economics literature, we develop a set of hypotheses as to how chains could address the quality failures that typify LMIC retail pharmacy markets, and explore these hypotheses using a set of 38 in-depth interviews, conducted in Bengaluru, India between 2014 and 2015. We look specifically at how being organised in a chain affects several key behaviours: employment of qualified staff; the ability of government authorities to focus regulation on central management structures; the propensity for firms to self-regulate; and the impact of the potentially lower-powered incentives faced by chain employees compared to independent owners. In practice, few differences were identified between chain and independent organisations in these areas. Not all chains were operating with a qualified pharmacist (akin to independent shops). Drug control authorities did not take advantage of the existing chain architecture to enforce regulation. Chains did heavily self-regulate but their focus was on customer service, rather than aspects of quality relevant to health outcomes. Additionally, widespread bribery in the sector was a barrier to effective drug control. Finally, the incentives faced by chain employees were not low-powered due to rewarding sales targets and pressure to increase sales. We observed that chains exerted strong influence over their staff but the potential to exploit this to improve quality of care is not currently being realised. A shift in focus from customer satisfaction to outcomes of public health concern is unlikely without either financial incentives or strengthened external regulation.