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

数字化被认为深刻影响着社会的各个领域。在这方面，一个特别有趣的部门是药品分销。其深层的制度结构已经发展了几个世纪，并影响了所有西方社会的医疗体系。其核心是药剂师和医生职业的制度分离。当前的数字技术浪潮导致了包括医疗保健行业在内的各种行业的所谓平台化。目前正在建立提供医疗咨询和药物交付的“一站式服务”平台，为了支持这种医药和医疗服务的整合，人们呼吁废除药剂师和医生职业的“历史分离”。欧洲历史上充满了对医疗保健行业这一深层次制度结构的挑战，迄今为止，这些挑战一直被抵御住了。因此，这个领域对于研究整个社会的数字化转型特别有趣，因为它提供了一个“关键案例”。因此，研究它在过去和现在的社会混乱之后应对挑战的方式，将为社会转型的潜在机制和动态提供线索，包括当前由新一代数字技术到来驱动的这一时期。本项目将研究药品分销组织发生重大变化的三个时期。在第一个时期（1800-1850年），药剂师和医生共同配制复杂药物的做法达到了高潮，在这两个职业的制度分离的范围内。在第二个时期（1910-1938），健康保险组织成为现代平台的原型，因为它们与药剂师和医生签订合同，对处方和分发的药物施加严格限制，并与药剂师谈判价格。这导致了两种职业的完全分离，即配方药物的联合实践失去了。第三，在当前时期（2010-2025年），再次出现了发展联合实践的可能性，这将药剂师和医生的两种实践再次紧密联系在一起，这一次的重点是药物治疗。药物的安全性日益成为一个重大的公共卫生问题，管理药物治疗被视为改善和优化药物治疗的一种方式。药剂师和医生是否会再次学会在药剂师和医生的制度分离的界限内合作，或者平台是否会成功地推翻这种分离，以便使用大数据分析技术来集中监督和优化药物治疗？

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?