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  • Remuneration and regulation of community pharmacy Literature review Department of Health

    November 2016

  • Liability limited by a scheme approved under Professional Standards Legislation. Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.com/au/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms.

    Contents Glossary ..................................................................................................................................... i

    Executive summary .................................................................................................................. iii

    1 Introduction .................................................................................................................... 1

    1.1 Scope of research and structure of report ......................................................................... 1

    1.2 Methodological approach to the research ......................................................................... 2

    2 Asia-Pacific ...................................................................................................................... 4

    2.1 Australia ........................................................................................................................... 4

    2.2 New Zealand ................................................................................................................... 16

    2.3 Japan .............................................................................................................................. 23

    3 North America .............................................................................................................. 30

    3.1 United States of America ................................................................................................. 30

    3.2 Canada ........................................................................................................................... 38

    4 Continental Europe ....................................................................................................... 45

    4.1 France............................................................................................................................. 45

    4.2 Spain............................................................................................................................... 51

    4.3 The Netherlands ............................................................................................................. 57

    4.4 Denmark ......................................................................................................................... 63

    4.5 Norway ........................................................................................................................... 69

    4.6 Sweden ........................................................................................................................... 75

    5 United Kingdom and Ireland .......................................................................................... 81

    5.1 United Kingdom .............................................................................................................. 81

    5.2 Ireland ............................................................................................................................ 88

    6 Analysis ......................................................................................................................... 94

    6.1 Health system context and expenditure .......................................................................... 94

    6.2 Remuneration and regulation.......................................................................................... 97

    6.3 Scope of services, settings and distribution ................................................................... 104

    6.4 Wholesaler supply arrangements .................................................................................. 108

    6.5 Adoption of technology ................................................................................................. 111

    6.6 Reforms, innovations and trials ..................................................................................... 113

    References ............................................................................................................................ 115

    Appendix A : Search terms for systematic search.................................................................. 138

    Limitation of our work .......................................................................................................... 143

  • Charts Chart 3.1 : Pharmacies per 100,000 in each jurisdiction, Canada ............................................. 42

    Chart 6.1 : Health expenditure, by country .............................................................................. 95

    Chart 6.2 : Per capita pharmaceutical expenditure, by country ................................................ 96

    Chart 6.3 : Number of pharmacists and pharmacies per 100,000 population, by country ...... 106

    Tables Table 1.1 : Results of the systematic search .............................................................................. 3

    Table 2.1 : Health care system indicators, Australia ................................................................... 5

    Table 2.2 : Dispensing and additional related fees, Australia ..................................................... 5

    Table 2.3 : AHI fee variation, Australia....................................................................................... 6

    Table 2.4 : Number of pharmacies and pharmacists, Australia ................................................... 9

    Table 2.5 : Wholesale mark-up, Australia ................................................................................ 11

    Table 2.6 : Estimated PBS and RPBS prescription volumes ....................................................... 13

    Table 2.7 : Growth of pharmacies and people employed by pharmacies ................................. 14

    Table 2.8 : Growth of pharmacies and people employed by pharmacies ................................. 15

    Table 2.9 : Australian historical health expenditure ................................................................. 16

    Table 2.10 : Health care system indicators, New Zealand ........................................................ 17

    Table 2.11 : Reimbursement schedule for pharmacies, New Zealand ...................................... 18

    Table 2.12 : Number of pharmacies and pharmacists, New Zealand ........................................ 20

    Table 2.13 : Health care system indicators, Japan .................................................................... 24

    Table 2.14 : Number of pharmacies and pharmacists, Japan.................................................... 27

    Table 3.1 : Health system indicators, USA ................................................................................ 31

    Table 3.2 : Number of pharmacies and pharmacists, USA ........................................................ 35

    Table 3.3 : Health care system indicators, Canada ................................................................... 38

    Table 3.4 : Number of pharmacies and pharmacists, Canada ................................................... 41

    Table 4.1 : Health care system indicators, France .................................................................... 46

    Table 4.2 : Number of pharmacies and pharmacists, France .................................................... 48

    Table 4.3 : Health care system indicators, Spain ...................................................................... 51

    Table 4.4 : Number of pharmacies and pharmacists, Spain ...................................................... 54

    Table 4.5 : Health care system indicators, the Netherlands ..................................................... 58

    Table 4.6 : Number of pharmacies and pharmacists, the Netherlands ..................................... 61

  • Table 4.7 : Health care system indicators, Denmark ................................................................ 65

    Table 4.8 : Number of pharmacies and pharmacists, Denmark ................................................ 67

    Table 4.9 : Health care system indicators, Norway .................................................................. 70

    Table 4.10 : Number of pharmacies and pharmacists, Norway ................................................ 73

    Table 4.11 : Health care system indicators, Sweden ................................................................ 76

    Table 4.12 : Number of pharmacies and pharmacists, Sweden ................................................ 78

    Table 5.1 : Health care system indicators, UK .......................................................................... 81

    Table 5.2 : Number of pharmacies and pharmacists, UK .......................................................... 85

    Table 5.3 : Health care system indicators, Ireland .................................................................... 89

    Table 5.4 : Number of pharmacies and pharmacists, Ireland ................................................... 91

    Table 6.1 : Pharmacy margins and dispensing fees, by country ................................................ 98

    Table 6.2 :

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