Advocacy coalitions and pharmacy policy in Denmark—Solid cores with fuzzy edges

Abstract

This paper presents the results from a qualitative study in which the Advocacy Coalition Framework (ACF) was used to analyze deregulation of the distribution of medicine in Denmark in October 2001. The study is based on qualitative methods, and it examines the policy process between 1996 and 2001. Data sources were documents and qualitative interviews. The results show that minor modifications of the ACF are needed to make it fully applicable to the case of pharmacy policy, especially when the policy process proceeds in a predominantly corporatist state. We found that the policy process was framed by two coalitions advocating different belief systems. One coalition wanted the pharmacy sector to be controlled by the state, the other wanted a full-scale liberalization. Throughout the process there was a general shift in policy core beliefs among the actors involved—moving from positively disposed towards a market-oriented reform to being more negatively disposed towards such a reform. We argue that two factors contributed to this. First, as the discussions about a reform became more specific, technical matters began to influence the actors. Second, the legitimacy of a solution which did not alter the regulation of the pharmacy sector radically, was reinforced by institutionalized norms that made politicians take onboard pharmacy professionals’ concerns.