In many of these developing countries, regulatory oversight is constrained by governments which lack the enforcement staff, budgets, or regulatory and judicial framework that exists in developed countries. Enforcement is made particularly difficult because the retail market in most low-income countries is highly fragmented: the number of formal pharmacies is small compared to the many different types of retailers, such as dispensing doctors, medicine sellers, drug sellers, and general stores that also sell a variety of drugs and health care remedies.
Within these diverse national structures, though, the retail pharmacy sector is facing a common set of global challenges.
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These include:. These macro changes are driving retail pharmacy to develop new strategies, moving away from business practices developed during the years of operating in a regulated environment with generally favorable trends. Because there was seen to be a public interest in health care delivery, pharmacy was established in virtually all countries subject to regulatory and operational standards that generally were accompanied by restrictions on ownership, entry, and competition. As economies and medicine developed, pharmacies were able to take advantage of this environment and build profitable enclaves with limited competition.
Even in the United States, the development of chain drug stores was largely regional in nature until the s. Overall, within each country, pharmacy retail was characterized by similar-sized businesses, with similar organizational structures, offering similar products and services, and producing similar operational and financial results. Eventually, costs and productivity became second-order concerns, while overall market growth and the rise of new long-term medicines drove dispensary volumes and profits up.
The capitalized value of drugstores grew markedly.
This environment led to competition within the club, with pharmacies becoming inwardly focused, defining markets and operations in terms of what they did, rather than in terms of what the customer might want or need. This approach was viable as long as markets were limited by regulatory or implicit geographical constraints.
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Indeed, favorable demographics and the development of medicines for chronic conditions cholesterol, hypertension allowed this industry structure—and pharmacy profitability—to persist in many countries. In contrast, the relatively open market in the United States led to large-scale entry by supermarkets and discount department stores into pharmacy and OTC medicines. This new competition spurred a wave of consolidation resulting in three major national drugstore chains by the early s Walgreens, CVS, and Rite Aid , as well as three large wholesale organizations Cardinal, AmerisourceBergen, and McKesson , each linked to a network of affiliated independent owner-operator pharmacies.
Pharmacy deregulation has tended to take place on a gradual basis, through liberalizing ownership and operating restrictions. The main exception to this was in Sweden, where the government had previously operated a monopoly system, Apotek. The government retained about one-third of the pharmacies to ensure continued service in rural areas; the remainder was sold in clusters to a variety of private equity groups.
This divestiture was accompanied by lowered restrictions on new entrants pharmacists have to operate the dispensary but do not have to own the business , resulting in about 15 percent new pharmacies. Restrictions on the sale of OTC medicines also were lowered, spurring more competition by established mass market retailers. In effect, Sweden is in the midst of a wholesale change in pharmacy retail. Phased liberalization has given pharmacies in most countries a window of opportunity to develop sound retail strategies.
These strategies should take into account the economic and competitive changes that are occurring, including 9 :. One of the leading thinkers on strategy, Michael Porter, has suggested that there are three generic strategic positions: focused niche strategies; cost leadership; and differentiation. Focused niche strategies can be successful when there is a limited, but highly profitable market with high entry barriers. The old world of pharmacy retailing was perhaps the classic example, because the profitability of the dispensary was almost self-supporting.
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Any other front-of-shop activities were incremental to business success and profitability. But, in the new world, the role of the dispensary is shifting from profit driver to traffic driver—with low profitability and the need to build a more complete retail model. Another focused strategy might be to concentrate on the premium segment. As appealing as this might be in the abstract, this has not been a big a segment as many imagined.
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In practice, strong differentiated competitors see below have been able to construct premium offers that reduce the strategic opportunity. In sum, focused strategies will be very challenging in the drugstore industry. Cost leadership strategies have driven many retail sectors in recent years for example, Walmart and Amazon. It is important to recognize that you cannot have a large number of cost leadership players, since a successful strategy requires volume and scale.
This almost inevitably results in only a few players in the end. Only 20 to 25 percent report that lowest prices are the reason they shop most often at a particular pharmacy. Given the large number of pharmacies and the inherent limitations of focus or cost leadership strategies, differentiation strategies would appear to offer the most appeal. Because of the dispensary, pharmacy retail has a good starting hand to play in a differentiated offer.
The need is to extend that difference to other categories, such as health and wellness, or beauty. While these categories have more extensive competition, they also tend to be product- and service-driven—characteristics that are clearly applicable to pharmacy retail.
But, such differentiation also requires exclusive, first-to-market, or private label products that are not available to mass merchants, which, in turn, requires access to global suppliers and networks. An example of this is the No. And will the country still have access to sensitive information and data-sharing systems?
Worryingly, there is a cautionary tale for this type of cooperation. This should serve as a stark reminder for both parties of the potential difficulties of cooperation in the years ahead. Outside EU structures, however, there are glimpses of a brighter future for UK involvement in the wider European theatre. Add to that the historically interventionist tendencies of the UK and France, along with their similar geopolitical interests, and the importance for both countries of meeting the target for CJEF operability appears clear.
Indeed, given that the UK is already well set up to work closely with its neighbour across the Channel, France will shortly become a strong ally for the country within the EU. In Britain, this may allay fears about the emergence of a Franco-German axis that dominates EU foreign policy.
Franco-German shared interests remain strong, and despite differences over new EU-level initiatives such as PESCO, the fact remains that little is known about whether and how the UK will eventually become involved in such arenas. Consequently, a strong bilateral UK-France partnership will, in British eyes, likely provide a suitable counterbalance. Here again, greater interoperability and flexibility — given the case-by-case, voluntary nature of the JEF coalition — should provide the UK with a ready-made platform for further coalition-building.
Ultimately, much will depend on the trajectory and final outcome of Brexit — especially in the short term. In recent months, the chances of both a no deal exit and a second referendum have risen, increasing uncertainty and further exposing key divisions between the UK and the EU on the way forward.
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Building coalitions beyond the confines of EU structures may increasingly appear to be an attractive option for the UK in particular as it casts around for new possibilities. Doing this without shutting itself off from potential future participation in new and existing EU structures will not be an easy tightrope to walk — not least with the wider economic ramifications of Brexit likely to spill over into other aspects of relations. EU Coalition Explorer research showing that the UK still regards itself as highly esteemed should be a warning for the country to dial down the bravado and listen closely.
The study surveys the cooperation preferences and attitudes of European policy professionals working in governments, politics, think tanks, academia, and the media to explore the potential for coalitions among EU member states. All across Europe, civil society actors and social movements are tirelessly working to challenge the status quo. Designing and testing future ways of democratic participation. Defending democracy as a culture and a practice. Redefining caring for our environment as a democratic right. Telling women's stories for more gender equality.
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Developing strategies to fight fake news or giving tools to citizens to effectively lobby their institutions for the better. Advocate Europe, as a civil society incubator, proudly presents the eight winning initiatives we will be mentoring through Like muscles in general, our democratic muscles require training — Democracy Fitness Denmark offers to strengthen these muscles in minute training sessions. The aim is to gather and train citizens from various European countries and to give them the methods and competences to select issues, design trainings and tutor citizens from their own context, creating an extended network of democracy trainers.
Why are we funding this project? Practising democracy fosters civic involvement and keeps participatory processes alive. A century after the uprising of the suffragettes and in the middle of the MeToo debate, Sisters of Europe Greece, Germany, France wants to foster inspiration and connection between women across Europe. The project aims to create a digital collection of interviews with engaged women from Europe and to host three Agorae in four different European Cities. By highlighting role models, building networks and offering concrete solutions, this project is a prototype of grass-roots gender democracy.
Although digital natives, teenagers encounter fake news on a daily basis in the digital realm. Using Augmented Reality and a free Escape Room App, EscapeFake Romania, Austria aims to teach school children between 12 and 18 the basic principles of fact-checking: read, cross-check, research and so - escape the fake.