The EU community pharmacy market: The density and its influencing factors

Schwaabe, Selina
Resea ch Repo
The EU communi y pha macy ma ke : The densi y and i s
in luencing ac o s
i gs Sch i en eihe de FOM, No. 32
P o ided in Coope a ion wi h:
FOM Hochschule ü Oekonomie & Managemen , i gs Ins i u ü Gesundhei & Soziales
Sugges ed Ci a ion: Schwaabe, Selina (2025) : The EU communi y pha macy ma ke : The densi y and
i s in luencing ac o s, i gs Sch i en eihe de FOM, No. 32, ISBN 978-3-89275-393-3, MA Akademie
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i gs Sch i en eihe
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32 The EU Communi y Pha macy Ma ke :
The Densi y and i s In luencing Fac o s
~
Selina Schwaabe
i
i
gs
gs
Ins i u ü Gesundhei & Soziales
de FOM Hochschule
ü Oekonomie & Managemen
Selina Schwaabe
The EU Communi y Pha macy Ma ke : The Densi y and i s In luencing Fac o s
i gs Sch i en eihe de FOM, Band 32
Essen 2025
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The EU Communi y Pha macy Ma ke :
The Densi y and i s In luencing Fac o s
Selina Schwaabe
Con ac :
Selina Schwaabe
Hochschule ü Poli ik/Technische Uni e si ä München
E-Mail: Selina.Schwaabe@h p. um.de
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
III
P e ace
Communi y pha macies deli e high-quali y heal h ca e and a e esponsible o
medica ion sa e y. The goal o he go e nmen is o ensu e na ionwide,
accessible, and a o dable medical heal h-ca e se ices p o ided by pha macies.
The e o e, he pe capi a densi y o communi y pha macies ma e s. O e all, he
densi y o communi y pha macies luc ua es, wi h sligh ly dec easing endencies
in some coun ies. So a , s udies ha e shown ha changes in he sys em a ec
p ices and densi y. Howe e , an o e iew o he de elopmen o he densi y o
Eu opean communi y pha macies and i s causes is s ill missing. This esea ch is
impo an o coun e ac dec easing densi y esul ing in a lack o p o essional
heal h ca e deli e ed h ough pha macies. I ocus on libe al e sus egula ed
ma ke s uc u es and he egula ion o mail-o de o p esc ip ion d ugs.
The densi y o communi y pha macies is inc easingly becoming he ocus o
heal h-ca e policies. The supply o na ionwide heal h-ca e se ices, especially
wi h ega d o ecen pandemics, is impo an . Communi y pha macies a e no
jus a coun e o p esc ip ion d ugs. They deli e high-quali y heal h ad ice and,
in some cases, can eplace a doc o ’s isi . Hence, a decline in he densi y o
communi y pha macies can a ec people’s heal h (ca e).
Du ing my esea ch, I collec ed da a on he numbe o communi y pha macies
pe 100,000 inhabi an s om 27 EU coun ies om 2000 o 2021. The mo i a ion
o his esea ch comes om bo h a heal h-ca e policy and a pe sonal
pe spec i e. I g ew up in a pha macis ’s household and wo ked a he amily’s
pha macy. Du ing his ime, I lea ned abou he di e ences in pha macy ma ke
egula ions h oughou he EU, which led me o ques ion wha in luences
pha macy densi y.

i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
IV
I am indeb ed o my supe iso s, P o . D . Tim Bü he and P o . D . Ch is ian
Adam, o hei con inuous help and ad ice. Thank you. Fu he , I would like o
hank P o . D . Ellen Scha heu le o he spon aneous, impo an inpu on he EU
communi y pha macy ma ke . In addi ion, I app ecia e he in o ma ion and ad ice
gi en by he esea ch g oup membe s o he in e na ional ela ions chai a he
TUM/H P. Fu he , I would like o hank D . Isabel Gödl-Hanisch, Julius Schmid ,
Cha lo e Hummel and Da id Schwei ze o hei eedback on his pape . I would
also like o ex end my g a i ude o he espec i e Eu opean pha macy
associa ions o p o iding me wi h he da a on pha macy densi y. My g a i ude
also goes o he i gs publica ion se ies o o e ing me he oppo uni y o publish.
I am pa icula ly g a e ul o P o . D . Da id Ma usiewicz and Sa ah Be ndsen.
Munich, Janua y 2025
Selina Schwaabe, M.A.
Technische Uni e si ä München/Hochschule ü Poli ik
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
V
Con en s
P e ace ................................................................................................................ III
Lis o Figu es ..................................................................................................... VI
Lis o Tables ...................................................................................................... VI
Lis o Abb e ia ions .......................................................................................... VII
1 In oduc ion ...................................................................................................... 1
2 Theo e ical F amewo k .................................................................................... 5
3 Empi ical De elopmen s .................................................................................. 9
4 Theo e ical Expec a ions ............................................................................... 11
5 Da a ............................................................................................................... 14
6 Me hod ........................................................................................................... 16
7 Resul s ........................................................................................................... 18
8 Discussion ..................................................................................................... 22
9 Limi a ions ..................................................................................................... 25
10 Conclusion ..................................................................................................... 26
Re e ences ......................................................................................................... 27
Appendix ............................................................................................................. 37
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
VI
Lis o Figu es
Figu e 1: E olu ion o pha macy densi y ....................................................... 45
Lis o Tables
Table 1: C oss-Sec ion Analysis .................................................................. 18
Table 2: Analysis o e ime (wi hin-e ec s) ................................................. 19
Table 3: O e iew o he de ini ion o gene al egula ions wi hin
libe al and egula ed EU pha macy ma ke s wi h examples .......... 38
Table 4: Gene al o e iew o egula ions wi hin he EU pha macy
ma ke , including all 27 EU coun ies............................................. 39
Table 5: O e iew o egula ions and hei changes in se en
selec ed coun ies .......................................................................... 41
Table 6: To al numbe o communi y pha macies in he EU om
2000-2021 ...................................................................................... 42
Table 7: Sou ces o Da a collec ion ............................................................. 44
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
VII
Lis o Abb e ia ions
ABDA
Bundes e einigung Deu sche
Apo heke e bände e. V.
AMP eisV
A zneimi elp eis e o dnung
DKMA
Danish Medicines Agency
e-p esc ip ion
elec onic P esc ip ion
EU
Eu opean Union
FIP
In e na ional Pha maceu ical Fede a ion
GDP pe capi a on PPP
G oss Domes ic P oduc pe capi a based on
pu chasing powe pa i y
H
Hypo hesis
INHS
I alian Na ional Heal h Se ice
NNF
Nach - und No diens ond
OTC
o e - he-coun e
POM
p esc ip ion only medicines
Rx
p esc ip ion
WHO
Wo ld Heal h O ganisa ion
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
7
does no a emp o speci y ou comes, a se o objec i es ha does no pe pe ua e
egula ion, bu , a he , le s i ecede as compe i ion p og esses” (Sidak & Spulbe ,
1998, p. 118). Howe e , i is necessa y ha “ egula o s should es ablish basic
ules o an o de ly ansi ion o compe i ion ha ely on compe i i e inno a ion
and cos cu ing as he sou ces o consume bene i s” (Sidak & Spulbe , 1998, p.
119). O e all, managed compe i ion is “a combina ion o libe aliza ion wi h e-
egula ion” mo e speci ic: “ ue de egula ion ( ee ma ke s and ewe ules)”
(Vogel, 2007, p. 33). The assump ion o e- egula ion by Vogel (2007, p. 34) is
as ollows:
The logic by which libe aliza ion d i es e- egula ion a ies
acco ding o he na u e o he p eexis ing egime and he cha ac e
o he ansi ion owa d g ea e compe i ion. A shi om monopoly
o compe i ion ypically equi es p o-compe i i e egula ion o jump-
s a compe i ion (…). A ansi ion om public o p i a e p o ision o
se ices o en equi es new egula ion o manda e public se ice
equi emen s such as uni e sal access o in e ope abili y) ha we e
p e iously me di ec ly by he public co po a ion. An inc ease in he
numbe and di e si y o ma ke playe s gene ally demands a mo e
codi ied egula o y egime (“mo e ules” in he li e al sense). And an
in ensi ica ion o compe i ion may spu companies o beha e wo se
( o p oduce g ea e ex e nali ies), he e o e equi ing mo e social,
en i onmen al, o o he ypes o p o ec i e egula ion.
The applica ion o managed compe i ion wi h egula ions has been pa icula ly
ele an in sec o s unde going libe aliza ion, such as elecommunica ions,
ene gy, anspo a ion, and inancial se ices. In hese cases, he g adual
disman ling o s a e monopolies o egula o y ba ie s has been accompanied by
he implemen a ion o egula o y amewo ks o ensu e ai compe i ion and
p o ec public in e es s (Vogel, 2007). I is also impo an o know wha managed
compe i ion is no . Fo example, En ho en (1993, pp. 44-45) explains ha i is no
de egula ion, i is no a ee ma ke , and “i is new ules, no no ules”.
Managed compe i ion con ols he en y in o a libe alized ma ke , ensu es ai
conduc by all ma ke playe s hus ac ing in he (end) consume ’s bes in e es .
En y ba ie s o he pha macy ma ke a e owne ship licenses, geog aphic and
demog aphic ules, minimum and maximum Rx d ug p ices, e ail concep s
(wo k o ce equi emen s), and p o ided se ices ( accina ions, diabe es
counseling, expanded asso men s such as cosme ics, and mo e)16. One speci ic
16 Which a e no conside ed in his analysis.

i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
8
ma ke ha has ecen ly wi nessed he applica ion o managed compe i ion
h ough egula ions is he pha macy ma ke .
The Swedish pha macy ma ke has changed om a egula ed ma ke o a ma ke
wi h managed compe i ion. Sweden’s pha macy ma ke wen om a s a e
monopoly o a mo e libe ally egula ed ma ke whe e a b oade se ice, new
selling places o ai compe i ion, and an imp o emen o se ice exis (Wisell,
2019; Wisell e al., 2016). As go e nmen s explo e a enues o libe alize his
adi ionally egula ed sec o , s iking he igh balance be ween compe i ion and
egula o y o e sigh becomes c ucial. The implemen a ion o managed
compe i ion p inciples, combined wi h a ge ed egula ions, p esen s a p omising
app oach o os e ing compe i ion while sa egua ding pa ien sa e y, main aining
access o quali y heal h ca e, and ensu ing he sus ainabili y o he pha macy
sec o . The nex sec ion b ie ly p esen s which egula ions and libe aliza ions
exis wi hin se e al EU coun ies.
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9
3 Empi ical De elopmen s
Sweden’s s a e-monopoly based pha macy ma ke was libe alized in 2009 o
in oduce mo e compe i ion. Pa s o he pha macy ma ke in Po ugal we e
libe alized by emo ing some egula ions ega ding he owne ship s uc u e in
2007. In Aus ia, so-called p i a e pa ne ships can in es in a pha macy since
2008. Howe e , he pha macis in cha ge has o hold mo e han 50 pe cen o
he business (Ös e eichische Apo heke kamme , 2020b). Ne e heless, he
ma ke has s uc u es o e- egula ion (libe aliza ion wi h mo e egula ion) in he
sense o ai compe i ion. Regula ion examples include geog aphic and
demog aphic ules o es ablishing a new pha macy o c ea e accessibili y and
ai ness. Fu he , in 2004, he Ge man go e nmen libe alized Rx mail-o de
wi hou changing exis ing p ice egula ions wi hin he coun y (libe aliza ion
wi hou new ules o compe i ion) (May e al., 2017). Due o he unchanged
es ic ions o Ge man pha macies ega ding Rx ixed p icing ules,17
pha macies could no wi hs and he p ice compe i ion because pha macies om
ab oad a e allowed o discoun he addi ional paymen on Rx (usually be ween
5 and 10 €) o he insu ed in he amoun o 10 pe cen o he pha macy
dispensing p ice (Bundesminis e ium ü Gesundhei , 2023). A s udy by May e
al. (2017) concluded ha his esul ed in a decline in he densi y o pha macies
in Ge many.
Due o he in e na ional end o libe alizing egula ed ma ke s, he o me
go e nmen o I aly unde P ime Minis e Ma io Mon i also discussed libe alizing
he I alian pha macy ma ke . A epo by Ga a ini e al. (2012) highligh ed ha
he libe aliza ion plan o he I alian pha macies would no change he policy goals
o be e accessibili y, lowe p ices, and mo e compe i ion.18 The esea che s
w i e:
The new law in I aly aims o enhance compe i ion in he pha macy
sec o by educing he his o ical es ic ions h ough libe aliza ion.
Howe e , a e ca e ul e alua ion, he new egula ions do no seem
o adically change his igh ly egula ed dis ibu ion channel. One o
he majo hu dles o a ee ma ke (i.e. owne ship es ic ions) will
emain and new shopping o ms (e.g. in e ne pha macies) will no
17 E e y Rx medicine has a ixed p ice in Ge many o ensu e ha he cus ome ge s he
same p ice in e e y pha macy. This p ice is no discoun able a Ge man local
pha macies.
18 Ne e heless, in 2017, he pha macy ma ke was libe alized by allowing non-
pha macis s o own a pha macy h ough pa ne ships o companies (Gallone e al.,
2020).
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
10
be in oduced. O he limi s, such as he demog aphic and
geog aphic ules o opening a new pha macy, ha e no been
cancelled, jus elaxed. An expec ed consequence is ha many
mo e pha macies could open, esul ing in edis ibu ion o INHS
emune a ion o app o ed d ugs.
In heo y, inc eased supply wi h equal demand could esul in
enhanced compe i ion. (Ga a ini e al., 2012, p. 25)
They u he ag ee wi h o he esea che s ha libe alizing he geog aphical ules
will no expand densi y (Ga a ini e al., 2012). I will inc ease densi y in he u ban
a eas, bu he densi y in u al a eas will emain low (u ban clus e ing) (Ga a ini
e al., 2012). In addi ion, cu en li e a u e exp esses ha libe alizing he
pha macy ma ke has di e en ou comes: pha macy chains will ha e a mo e
signi ican in luence while smalle e ail pha macies ha e o close (Ca ballada &
Lois-González, 2022).
Compe i ion p omises posi i e impac s on he eedom o choice o he public
and an inc ease in he numbe o communi y pha macies (Gallone e al., 2020;
Vogle , 2014; Wisell e al., 2016). These posi i e expec a ions ha e no been
con i med in all libe alized pha macy ma ke s. F om he li e a u e one ga he s
ha he libe aliza ion o he pha macy ma ke is associa ed wi h alse
expec a ions o mo e compe i ion due o mo e playe s wi hin he ma ke – o
example, in Sweden. (Vogle e al., 2006; Wisell, 2019). Wisell (2019, p. 36)
a gues ha he libe aliza ion e o m was made “wi hou he necessa y esea ch
on he possible consequences”. Fu he , she explains ha libe alizing he ma ke
was no based on a ional a gumen s bu mainly on an ideology. (…)
p i a iza ion pe se seemed o be an impo an a ionale in he
abolishmen o he monopoly. The idea o how i ough o be was
p io i ized o e wha was p obably going o be, based on he
e idence a hand. (Wisell, 2019, p. 36)
While libe alizing pa s o he ma ke , o he egula ions emain s ong, such as
geog aphic and demog aphic ules (Ca ballada & Lois-González, 2022; Ran s,
2014).
Using he co e ideas o he managed-compe i ion app oach, his analysis
explains how libe aliza ion o he pha macy ma ke in he ield o owne ship and
Rx mail-o de impac s densi y. The nex pa o his pape desc ibes he
hypo heses acco ding o he heo e ical app oach.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
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4 Theo e ical Expec a ions
Highe pha macy densi y has been associa ed wi h imp o ed19 accessibili y o
heal h-ca e se ices, enhanced medica ion a ailabili y,20 and inc eased
compe i ion, which may esul in lowe p ices and highe quali y o ca e (Vogle ,
2014; Wisell e al., 2016; Wiśniewski e al., 2020). The expec a ions de i ed om
he discussion abo e posi ha he numbe o pha macies wi hin a ma ke will
ise by elaxing owne ship es ic ions and allowing a mo e di e se ange o
owne s, such as independen pha macis s o non-pha macis in es o s.
P oponen s o his hypo hesis a gue ha libe aliza ion s imula es en ep eneu ial
ac i i y, a ac s in es men s, and os e s a compe i i e en i onmen , ul ima ely
leading o an expansion o pha macy se ices and inc eased accessibili y o
pa ien s (Cla a, 2011; Vogle , 2014; Wisell, 2019; Wisell e al., 2016).
The oughe he es ic ions on opening a pha macy a e, he ewe pha macies
exis . Following he ideas o managed compe i ion, libe al ma ke s (libe al
pha macy owne ship)21 can u he inc ease compe i ion. In addi ion, esea che s
discuss a highe densi y when changing om a egula ed o a libe al ma ke , wi h
mo e compe i ion (BWB, 2018; Eila d, 2015; Gallone e al., 2020; Vogle e al.,
2006; Vogle e al., 2012; Wiśniewski e al., 2020). Di e ences be ween libe al
and egula ed ma ke s a e some imes ha d o spo . The pha macy ma ke is
libe al i he owne ship is no es ic ed o pha macis s. Hence, he pha macy
ma ke is egula ed i he owne ship is 100 pe cen es ic ed o pha macis s. This
dis inc ion be ween libe al and egula ed was chosen based on he exis ing wo k
o he wo egula o y ma ke s wi hin pha macy esea ch (Pu cell, 2004; Vogle e
al., 2014; Wiśniewski e al., 2020; Wo ld Heal h O ganiza ion, 2019).
Theo e ically, ollowing he deba e in p e ious li e a u e, his analysis expec s a
co ela ion be ween pha macy densi y and pha macy owne ship egula ions
(libe al s. egula ed). Acco dingly, ollowing he co e ideas o managed
compe i ion, a libe al pha macy ma ke , meaning libe al owne ship, is expec ed
o inc ease pha macy densi y. The e o e, he i s hypo hesis is as ollows:
19 By imp o emen , his analysis means mo e se ices a ailable a he pha macy, a
b oade choice o p oduc s, longe opening hou s, digi aliza ion, la ge s ock o d ugs,
e c.
20 Licensed pha macis s a e also a highly sough -a e p o ession in he pha maceu ical
indus y. Due o he economic size o he pha maceu ical indus y, hese pha macis s
can be paid be e , and he wo king hou s a e mo e lexible han in he e ail sec o o
he pha macy.
21 In e e y libe al owne ship ma ke , egula ions on u he ma ke egula ions exis s.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
12
H1: Libe alizing he owne ship s uc u e inc eases pha macy densi y.
Pha macy densi y e e s o he concen a ion o communi y pha macies wi hin a
speci ic geog aphical a ea. Densi y has long been iewed as a measu e o heal h-
ca e accessibili y and he a ailabili y o p esc ip ion medica ions (Wo ld Heal h
O ganiza ion, 2019). Wi h he ad en o echnology, Rx mail-o de se ices ha e
eme ged as an al e na i e means o pa ien s o ob ain hei p esc ip ion
medica ions con enien ly h ough mail deli e y.
The nex hypo hesis sugges s ha by libe alizing Rx mail-o de se ices, pa ien s
may inc easingly op o his con enien op ion, leading o educed demand o
adi ional pha macies. May e al. (2017) a gue ha he e is a decline in Ge man
pha macy densi y due o o eign compe i ion ad an ages ega ding Rx mail-
o de .22 In mos EU coun ies, Rx mail-o de is p ohibi ed, egula ed wi h p icing
ules, o limi ed o communi y pha macies (no online pha macies, i.e.,
pha macies wi hou an on-si e s o e). The densi y is mo e o less s able ( o
example, in Denma k).
I can be assumed ha libe aliza ion o Rx mail-o de (wi hou new ules) will
inc ease he likelihood ha pa ien s buy hei d ugs whe e hey a e cheapes (May
e al., 2017; Roh e , 2021). In Ge many, because o compe i i e disad an ages,
Rx d ugs a o eign pha macies a e no bound o Ge man Rx p icing ules (May
e al., 2017). Howe e , his is a pa icula case o Ge many. Ne e heless, he
cus ome buys he medica ion whe e i is cheapes and easies o buy: in
d ugs o es, supe ma ke s, gas s a ions, o ab oad. P esc ip ions can secu e he
p ima y income o a pha macy. The ewe sales gene a ed by Rx on-si e, he
lowe he g oss p o i (Deu sche Apo heke Zei ung, 2022). Because o missing
ules o compe i ion, he densi y will decline. Hence, he unde lying p esump ion
is a dec easing densi y o pha macies due o he mail-o de pe mission o Rx.
Thus:
H2: Libe alizing Rx mail-o de educes pha macy densi y.
22 Rx mail-o de only exis s in he ollowing EU coun ies: Sweden, Ge many, Denma k,
he Ne he lands, Mal a, Finland, Es onia. I only men ion Ge many as an example
because o he compe i i e ad an ages on p ices o Rx, which is unique.

i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
13
Besides he egula ion o owne ship and Rx mail-o de , se e al egula ions could
impac pha macy densi y. The cu en li e a u e on communi y pha macy
esea ch discusses he in luence on pha macy densi y by he G oss Domes ic
P oduc pe capi a based on pu chasing powe pa i y (cons an 2017 in e na ional
$, GDP pe capi a on PPP), he numbe o pha macis s pe 100,000 inhabi an s,
he p opo ion o he numbe o he popula ion aged 65 and o e (+), i he e a e
egula ions on geog aphic and demog aphic ules, and he numbe o medical
doc o s pe 100,000 inhabi an s (In e na ional Pha maceu ical Fede a ion - FIP,
2017; Wo ld Heal h O ganiza ion, 2019). A posi i e co ela ion in densi y is
expec ed due o he numbe o pha macis s because e e y pha macy needs a
pha macis who is a ailable du ing opening hou s (Gallone e al., 2020; Wo ld
Heal h O ganiza ion, 2019; Zelnio e al., 1984). The e o e, he mo e pha macis s
he e a e, he mo e pha macies can exis . This holds ue, o example, i he
maximum numbe o pha macies wi hin a speci ic a ea o o a speci ic numbe
o inhabi an s is no ul illed. Pha macies a e es ablished whe e doc o s o
medical cen e s a e in p oximi y, so pa ien s can be e e ed o a pha macy and
easily access he pha macy o p esc ip ions (Wo ld Heal h O ganiza ion, 2019).
Hence, mo e pha macies a e needed i he numbe o medical doc o s inc eases.
Ano he eason o highe densi y could be he numbe o he popula ion aged
65+ because he elde ly need mo e medica ion (Wo ld Heal h O ganiza ion,
2019).23 Finally, geog aphic and demog aphic24 ules a e discussed o secu e
compe i ion and egula e densi y (In e na ional Pha maceu ical Fede a ion - FIP,
2017; Vogle e al., 2014; Wo ld Heal h O ganiza ion, 2019). The nex pa
p esen s he da a and me hods used and analyzes he ou pu .
23 Such as ca dio ascula disease, diabe es, Alzheime ’s disease, join pain, and
cance .
24 This analysis only cap u es i geog aphic and demog aphic ules exis s o no . Fu he
de ini ions a e no included due o complexi y o he ules ega ding each coun y and
each ci y.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
14
5 Da a
This s udy employs a comp ehensi e analysis o in es iga e he ac o s
in luencing pha macy densi y ac oss 27 EU coun ies du ing he pe iod spanning
om 2000 o 2021. The objec i e is o explo e he de e minan s o pha macy
densi y and e alua e he in luence o speci ic owne ship cha ac e is ics,
p esc ip ion d ug dis ibu ion me hods, and a ious socio-economic ac o s (see
mo e de ails on sou ces o da a in Appendix 2 Table 7). The da a on pha macy
densi y25 p ima ily comes om he p o ided da ase by he Fede al Union o
Ge man Associa ions o Pha macis s (“Bundes e einigung Deu sche
Apo heke e bände e. V.”, sho : ABDA), which is used o hei annual epo
“Figu es Da a Fac s”. This da ase was supplemen ed and comple ed wi h he
help o annual epo s on pha macies om espec i e pha macy associa ions
(Ap eekka ilii o, 2023; Ös e eichische Apo heke kamme , 2023; S a is ics
Poland, 2023). Di ec email inqui ies we e made o he ele an heal h minis ies
o all 27 EU coun ies o ob ain addi ional da a on pha macy densi y. Due o he
lack o da a on pha macy densi y om 2000 o 2010, he e a e mo e obse a ion
gaps in he da ase . In o ma ion ega ding he pe mission o p esc ip ion d ug
mail-o de se ices was ob ained om he annual epo s o he ABDA (ABDA,
2020a, 2020b, 2021) and a epo by he Wo ld Heal h O ganiza ion (WHO)
(Wo ld Heal h O ganiza ion, 2019). The da a on GDP pe capi a on PPP (cons an
2017 in e na ional $) is sou ced om he Wo ld De elopmen Indica o s da abase
2022 (The Wo ld Bank, 2023). Fu he mo e, he numbe o pha macis s pe
100,000 inhabi an s was ob ained om he WHO Eu opean Da a Wa ehouse
(2023) and Eu os a (2023), and he numbe o doc o s pe 100,000 inhabi an s
was also aken om Eu os a (2023). The p esence o geog aphical and
demog aphic ac o s was il e ed om he li e a u e (ABDA, 2020a, 2021;
Ca ballada & Lois-González, 2022; In e na ional Pha maceu ical Fede a ion -
FIP, 2017; Vogle e al., 2014; Wo ld Heal h O ganiza ion, 2019). Da a on he
p opo ion o he popula ion aged 65 and o e was aken om Eu os a (2022)
and In e na ional Pha maceu ical Fede a ion - FIP (2017).
Da a on pha macy densi y has been collec ed om all EU coun ies om 2000
un il 2021.26 The key a iables o in e es a e he densi y o pha macies o each
25 See Table 6 in Appendix 1 o an o e iew o he numbe o communi y pha macies
pe 100,000 inhabi an s o 27 EU coun ies om 2000-2021.
26 I choose he ime ame o co e impo an changes wi hin he pha macy ma ke , which
could ha e in luenced densi y like he pe mission o Rx mail-o de , he online sale o
d ugs, and se e al ma ke egula ion changes. Fu he , he e is no o he s udy, which
co e s he las 21 yea s.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
15
EU coun y o e ime, he owne ship ma ke model, and he Rx mail-o de . This
pape explains he a ia ion in pha macy densi y, using he pha macy densi y pe
100,000 inhabi an s27 in each EU coun y as he dependen a iable. Fu he , he
main wo bina y independen a iables a e he pha macy ma ke model (0 =
egula ed/1 = libe al), and he Rx mail-o de (no = 0/yes = 1). Con ol a iables
a e in oduced o socio-economic ac o s, including he GDP pe capi a on PPP
(adjus ed o pu chasing powe pa i y), geog aphical cha ac e is ics (i
geog aphic and demog aphic ules exis ; change om 0, no, o 1, yes), popula ion
demog aphics (speci ically he p opo ion o he popula ion aged 65 and o e ),
and he numbe o pha macis s and medical doc o s pe 100,000 inhabi an s.28
27 In pha macy esea ch, i is a s anda d o analyze he accessibili y and co e age o
pha macies h ough he densi y pe 100,000 inhabi an s.
28 Assuming he popula ion is ge ing olde , he need o pha macies, p edominan ly
medica ion, is inc easing. Fu he , managed compe i ion will ule he ma ke i
demog aphic and geog aphic ules exis . An inc easing numbe o medical doc o s
and pha macis s could posi i ely a ec pha macy densi y as well.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
16
6 Me hod
This s udy employs wo s a is ical modeling app oaches o examine he
de e minan s o pha macy densi y ac oss EU coun ies: c oss-sec ional analyses
and ixed-e ec s panel analyses. These me hods we e chosen o cap u e bo h
he di e ences be ween coun ies and he changes wi hin coun ies o e ime.
Toge he , hey p o ide comp ehensi e insigh s in o he ac o s in luencing
pha macy densi y.
Fou models we e de eloped o he c oss-sec ional analyses. Model 1 includes
a b oad ange o egula o y and demog aphic a iables, such as hi d-pa y
owne ship allowance, Rx mail-o de allowance, and geog aphic and
demog aphic es ic ions. I se es as a baseline analysis o explo e gene al
associa ions be ween hese a iables and pha macy densi y. Model 2
inco po a es GDP pe capi a and he numbe o pha macis s pe 100,000
inhabi an s in addi ion o he a iables in Model 1. Coun ies wi h missing da a o
speci ic a iables we e excluded o inc ease he accu acy o he analysis. This
model aims o assess he impo ance o economic and labo ma ke ac o s in
in luencing pha macy densi y. Model 3 ocuses on a iables ha we e a leas
weakly signi ican in Model 2. By educing he numbe o a iables, he analysis
becomes mo e e icien , examining whe he he p e iously obse ed
ela ionships a e obus . Model 3’ was de eloped o e i y he obus ness o he
esul s by excluding G eece due o i s speci ic cha ac e is ics. This model helps
iden i y po en ial ou lie s and ensu e he s abili y o he indings. The c oss-
sec ional analyses p o ide an o e iew o coun y-speci ic di e ences and allow
o he iden i ica ion o gene al ends and ela ionships be ween he a iables
and pha macy densi y.
In addi ion o he c oss-sec ional analyses, ixed-e ec s panel analyses we e
conduc ed o examine changes wi hin coun ies o e ime. This me hod accoun s
o unobse ed coun y-speci ic cha ac e is ics ha emain cons an o e ime,
isola ing he e ec o he a iables o in e es . Two ixed-e ec s models we e
c ea ed. Fixed-E ec s Model 1 includes a iables such as GDP pe capi a, hi d-
pa y owne ship allowance, Rx mail-o de allowance, geog aphic and
demog aphic es ic ions, he pe cen age o he popula ion o e 65, he numbe
o pha macis s pe 100,000 inhabi an s, and he numbe o doc o s pe 100,000
inhabi an s. I in es iga es he impac o hese a iables on pha macy densi y
wi hin coun ies o e ime. The ixed-e ec s Model 2 excludes non-signi ican
a iables ( hi d-pa y owne ship allowed and doc o s pe 100,000 inhabi an s) o
inc ease he e iciency o he analysis. This model checks he obus ness o he
signi ican a iables om Model 1 and ocuses on he main in luencing ac o s.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
23
The ixed-e ec s wi hin analysis p o ide a di e en pe spec i e by ocusing on
he changes wi hin coun ies o e ime, accoun ing o unobse ed coun y-
speci ic cha ac e is ics. Model 1 (Fixed-E ec s) includes GDP pe capi a, hi d-
pa y owne ship allowed, Rx mail-o de allowed, geog aphic and demog aphic
es ic ions, he pe cen age o he popula ion o e 65, he numbe o pha macis s
pe 100,000 inhabi an s, and he numbe o doc o s pe 100,000 inhabi an s. This
model e eals ha GDP pe capi a and he numbe o pha macis s pe 100,000
inhabi an s a e signi ican posi i e p edic o s o pha macy densi y, while he
pe cen age o he popula ion o e 65 is a signi ican nega i e p edic o . The ixed-
e ec s model highligh s he impo ance o economic and wo k o ce ac o s while
con olling o ime-in a ian cha ac e is ics wi hin coun ies. Model 2 (Fixed-
E ec s) e ines he analysis by excluding he non-signi ican a iables ( hi d-pa y
owne ship allowed and doc o s pe 100,000 inhabi an s). This model con i ms he
obus in luence o GDP pe capi a and he numbe o pha macis s pe 100,000
inhabi an s, wi h bo h a iables emaining signi ican . The pe cen age o he
popula ion o e 65 con inues o show a signi ican nega i e associa ion. This
e ined model, wi h a highe wi hin R-squa ed alue o 0.3833, demons a es
imp o ed explana o y powe and e iciency.
Compa ing he esul s o he c oss-sec ional and ixed-e ec s wi hin analyses
p o ides a comp ehensi e unde s anding o he ac o s in luencing pha macy
densi y. Bo h analy ical app oaches consis en ly show ha GDP pe capi a is a
signi ican p edic o o pha macy densi y, unde sco ing he impo ance o
economic p ospe i y in suppo ing pha macy in as uc u e, as weal hie coun ies
a e be e equipped o main ain a highe densi y o pha macies. The numbe o
pha macis s pe capi a is ano he consis en posi i e p edic o ac oss bo h
me hods, highligh ing he c i ical ole o wo k o ce a ailabili y in ensu ing
adequa e pha macy se ices.
The pe cen age o he elde ly popula ion is a signi ican nega i e p edic o in he
ixed-e ec s analysis, indica ing ha highe heal hca e needs among he elde ly
a e no me by me ely inc easing he numbe o pha macies. The allowance o
Rx mail-o de shows a po en ial nega i e impac on pha macy densi y in he
c oss-sec ional models, hough he e idence is mixed. This sugges s ha policies
acili a ing mail-o de p esc ip ions migh educe he need o physical
pha macies.
The exclusion o G eece in he c oss-sec ional analysis (Model 3’) and he con ol
o coun y-speci ic cha ac e is ics in he ixed-e ec s analysis bo h highligh he
impo ance o accoun ing o unique na ional con ex s in c oss-na ional s udies.
These adjus men s imp o e he obus ness and signi icance o he indings.

i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
24
Summa izing he esul s shows ha ma ke egula ions do no play a ole in
pha macy densi y. This analysis ejec s H1. Fu he mo e, his analysis does no
accep H2. Rx mail-o de does no ha e a s a is ically signi ican in luence on
pha macy densi y. An impo an esul o his analysis is ha economic capaci y
and wo k o ce a ailabili y a e c ucial ac o s, while demog aphic and egula o y
a iables also play signi ican oles. Combining he libe aliza ion p ocess wi h he
co e ideas o managed compe i ion, i becomes clea ha wi hou es ablishing
new ules in a libe alized ma ke , goals o mo e compe i ion, b oade se ice, and
highe densi y a e ha de o achie e. In conclusion, he combined insigh s om
bo h analy ical app oaches emphasize he mul i ace ed de e minan s o
pha macy densi y. Policymake s should conside hese de e minan s o op imize
pha macy se ices and add ess heal hca e accessibili y challenges in di e en
na ional con ex s. Fu he esea ch should shed mo e ligh on new ules a e
libe aliza ion and how new ules can a ec densi y beha io – o each coun y
indi idually; especially, how mo e pha macis s can lead o highe pha macy
densi y.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
25
9 Limi a ions
The da a is limi ed due o gaps in esea ch da a.31 A di e ence-in-di e ence
design was no possible due o he sho obse a ion ime be o e a policy
changed and due o gaps in esea ch da a. Fu he mo e, his s udy is limi ed o
he EU pha macy ma ke . Addi ional esea ch migh include Swi ze land, he
Uni ed Kingdom, Iceland, Liech ens ein, and No way. Addi ionally, only Rx mail-
o de is analyzed in his s udy – no OTC mail-o de . Fu he , ex e nal deli e y
se ices a e no included.32 As men ioned abo e, his pape does no measu e
he quali y o pha macies o he se ices hey p o ide. Due o he uni o m
manda e o all pha macies o supply he popula ion wi h medica ion h oughou
he coun y and he ac ha he e is no compe i ion due o ixed p ices, a s udy
o he pha macies’ heal h-ca e quali y canno be ca ied ou wi hin his analysis
and should be conside ed o u he esea ch. The ange o se ices o e ed
canno measu e he quali y o a pha macy, as his is de e mined by a ious
economic ac o s (loca ion, specialis pha macy, s a , size, amily business, e c.),
which a e no quan i ied. This s udy is limi ed o he se ice o communi y
pha macies o deli e Rx. This s udy does no conside changes in egula ions
wi hin he d ug ma ke . Likewise, i does no in es iga e he possible e ec s o
he COVID-19 pandemic ( o example an ex ended online ma ke , in luence o
accina ion a he pha macy, dis ibu ion o masks and glo es, e c.).
31 A e con ac ing se e al minis ies o heal h and di e en lobby g oups o communi y
pha macies in e e y single EU coun y, his da ase includes all a ailable da a on
pha macy densi y pe 100,000 inhabi an s.
32 Rules ega ding he deli e y se ice o (OTC/Rx) d ugs di e signi ican ly h oughou
he EU.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
26
10 Conclusion
In sum, ma ke egula ions like owne ship and a ban on Rx mail-o de do no
signi ican ly suppo he inc ease in pha macy densi y in his speci ic s udy.
Policymake s and heal h-ca e p o ide s should conside implemen ing s a egies
o enhance he a ailabili y o pha macis s o mee he g owing demand o
pha macy se ices. This would help o be e manage he alloca ion o
pha macis s ac oss pha macies, he eby enhancing pha macy densi y and
imp o ing heal hca e accessibili y.
i gs Sch i en eihe, Vol. 32, Schwaabe: The EU Communi y Pha macy Ma ke
27
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i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
39
Table 4: Gene al o e iew o egula ions wi hin he EU pha macy ma ke ,
including all 27 EU coun ies33
Coun y Pha m-
acy
Sys em
Digi al-
iza ion:
e-
p esc ip
ion
Vaccina-
ion
agains
in luenza
Rx-Mail-
O de
P ohi-
bi ion o
hi d-
pa y
owne -
ship
OTC
Sale
ou side
Pha m-
acy
Geo-
g aphic
and demo-
g aphic
ules
Aus ia libe al yes no no no yes yes
Belgium libe al yes no no no no yes
Bulga ia libe al yes no no no yes no
C oa ia libe al yes yes no no no yes
Cyp us egula ed yes yes no yes no no
Czech
Republic
libe al yes no no no yes no
Denma k egula ed yes yes yes yes yes
no, only o
b anches
Es onia egula ed yes no yes yes yes yes
Finland egula ed yes no yes yes yes no
F ance egula ed no yes no yes yes yes
Ge many egula ed yes Pilo
P ojec
yes yes yes no
G eece egula ed yes yes no yes yes yes
Hunga y egula ed yes no no yes yes yes
I eland libe al yes yes no no yes no
I aly libe al yes no no no yes yes
La ia egula ed yes no no yes yes yes
Li huania egula ed yes no no yes yes yes
33 No da a = esea ch gaps because o missing da a.

i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
40
Luxem-
bou g
egula ed yes no no yes no yes
Mal a egula ed yes no yes yes yes yes
Ne he -
lands
libe al yes no yes no yes no
Poland egula ed yes no no yes yes yes
Po ugal libe al yes yes no no yes yes
Romania egula ed yes no no yes yes yes
Slo akia libe al yes no da a no no no yes
Slo enia libe al yes no no no yes yes
Spain egula ed yes no no yes yes yes
Sweden libe al yes no yes no yes yes
Sou ce: based on ABDA, 2020a, 2020b, 2021; PGEU, 2020; Wo ld Heal h
O ganiza ion, 2019.
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
41
Table 5: O e iew o egula ions and hei changes in se en selec ed
coun ies
Sou ce: da a based on ABDA, 2020a, 2021; Balgå d, 2012; BWB, 2018;
Ka unen, 2020; Mossialos & S i as a a, 2008; Ribei o e al., 2020; Vogle ,
2014; Vogle e al., 2006; Vogle e al., 2012; Wiśniewski e al., 2020; Wo ld
Heal h O ganiza ion, 2019.
EU Coun y (Case S udy)
Pha macy
Sys em
Regula ion
change
Rx mail-o de
Regula ion
change
3 d pa y
owne ship
Regula ion change Regula ion on dis ance Reason why coun y selec ed
Aus ia libe al yes, 2004 no no yes
in 2008 (so-called
Pe sonengesellscha en
can in es )
yes, so-called
Gebie sschu z, minimum
dis ance o 500m
Regula ed pha macy sys em including
egula ion on dis ance and no RX mail-
o de . The densi y is consis an y ising
Denma k egula ed no yes no da a no no yes, o b anches
Regula ed pha macy sys em including
new ule on expanding b anches
Finland egula ed no yes no da a no no
no, wi hou minimum
dis ance
Regula ed pha macy sys em bu
wi hou egula ion on dis ance: Coun y
wi h highes e-p esc ip ion usage in
EU
Ge many egula ed no yes in 2004 no no
no, so-called
Niede lassungs eihei
Regula ed pha macy sys em including
eedom o es ablishmen and RX mail-
o de
Poland egula ed
yes, in 2002
and 2017
no no da a
yes, om 2002-
2017
yes, in 2002 and in 2017
yes, 3,000 inhabi ain s o
se e and 500m o 1km
dis ance
Regula ed pha macy sys em wi h wo
changes in he sys em since 2002
Po ugal libe al yes, in 2007 no no yes
in 2007 (no wholesale s
a e allowed o un and
own a pha macy)
yes, 3,500 inhabi ain s o
se e, minimum dis ance
o 250m
Libe al pha macy sys em wi h change
in he sys em since 2007 bu wi hou
RX mail-o de
Sweden libe al yes, in 2009 yes in 2001 yes
in 2009 (including
wholesale s)
no
Libe al pha macy sys em wi h
absolu ely no egula ions on RX mail-
o de , 3 d pa y owne ship and
dis ance
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
42
Table 6: To al numbe o communi y pha macies in he EU om 2000-202134
34 Including esea ch gaps due o missing da a. Illus a ion based on my esea ch
esul s; numbe s a e ounded up.
Coun y 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Aus ia 14 14 14 14 14 14 15 15 15 15 15
Belgium 49 48 47
Bulga ia 57
C oa ia 25
Cyp us 42 40 40 40 40 40
Czech Republic 19 20 21 21 22 23 23 23 22 23 23
Denma k 6 6666
Es onia 30 30 32 35 35 35 40 39 38 37 36
Finland 15 15 15 15 15 15 15 15 15 15 15
F ance 38 37 37 36 36 36 35
Ge many 26 26 26 26 26 26 26 26 26 26 26
G eece 99
Hunga y 24 25
I eland 31 31 31 31 32 32 37 38
I aly 29 30 30
La ia 42
Li huania 48
Luxembou g 18 18
Mal a 51
Ne he lands 10 10 10 10 11 11 11 12 12 12 12
Poland 25 26 26 27 28 28 28 30
Po ugal 24 26 26 26 27
Romania 34
Slo akia 19 25 29 36 36
Slo enia 12 12 13 13 13 14 14 14 14 15 15
Spain 48 48 48 48 47 47 46 46 46 46
Sweden 99999910 910 10 12
Coun y 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Aus ia 15 15 15 15 16 16 16 16 16 16 16
Belgium 45 45 44 45 44 44 44 43 42 42
Bulga ia 56 51 50 51 51 51 46 46 46
C oa ia 24 26 26 26 26 26 28 28 28
Cyp us 55 55 54 57 60 60 62 62 61 61 63
Czech Republic 23 24 25 25 25 24 24 24 24 24 24
Denma k 6666678889
Es onia 36 35 36 36 35 38 38 37 38 37 38
Finland 15 15 15 15 15 15 15 15 15 15 15
F ance 35 35 35 34 35 33 33 32 32 31 32
Ge many 26 26 26 25 25 25 24 24 23 23 23
G eece 99 99 87 99 87 87 87 88 88 88
Hunga y 25 24 24 24 23 23 23 23 23
I eland 38 40 40 39 39 39 39 38 38
I aly 30 30 30 30 31 31 32 32
La ia 42 43 37 43 37 37 44 44 44 43 43
Li huania 47 47 45 47 45 45 47 47 47 47 47
Luxembou g 15 18 17 16 16 16 15 15
Mal a 51 51 51 51 51 49 49 49
Ne he lands 12 12 12 12 12 12 12 12 12 12 12
Poland 31 32 30 33 30 30 38 38 36 36 36
Po ugal 28 28 28 28 28 28 28 28 28 28
Romania 32 43 40 40 43 43 44 44 44
Slo akia 36 28 36 36 28 28 37 37 37
Slo enia 15 15 15 16 16 16 16 16 16 16 16
Spain 46 46 46 47 46 47 47 47 47 47 47
Sweden 13 13 13 14 14 14 14 14 14 14 14
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
43
Coun y
Sou ce o he numbe s
Aus ia
Vogle e al. (2012); ABDA (2021b); Ös e eichische Apo hekenkamme
(2021)
Belgium
Belgian Pha maceu ical Associa ion (2021); ABDA (2021b)
Bulga ia
ABDA (2021b); Minis y o Heal h Republic o Bulga ia (2021)
C oa ia
ABDA (2021b); Minis y o Heal h o he Republic o C oa ia (2021)
Cyp us
ABDA (2021b); Minis y o Heal h o Cyp us (2021)
Czech Republic
ABDA (2021b)
Denma k
ABDA (2021b); Vogle e al. (2012); Denma k Chambe o Comme ce
(2021)
Es onia
ABDA (2021b)
Finland
ABDA (2021b); Vogle e al. (2012)
F ance
ABDA (2021b); O d e Na ional de Pha maciens (2021)
Ge many
ABDA (2021b)
G eece
ABDA (2021b); Minis y o Heal h G eece (2021)
Hunga y
ABDA (2021b); Minis y o Na ional Resou ces o Hunga y (2021)
I eland
ABDA (2021b), Vogle e al. (2012); Pha maceu ical Socie y o I eland
(2021)
I aly
ABDA (2021b); Fede a ma.i (2023); Fede a ma.i (2025)
La ia
ABDA (2021b); S a e Agency o Medicines Republic o La ia (2025)
Li huania
ABDA (2021b), S a e Agency o Medicines Republic o La ia (2025)
Luxembou g
ABDA (2021b); pha macie.lu (2025)
Mal a
ABDA (2021b); The Minis y o Heal h and Ac i e Ageing in Mal a
(2021)
Ne he lands
ABDA (2021b); S a is a (2025); S ich ing Fa maceu ische Kenge allen
(2021)
Poland
ABDA (2021b); S a is ics Poland (2023)
Po ugal
ABDA (2021b); In a med (2021)
Romania
ABDA (2021b); P ess cen e o he Minis y o Heal h in Romania
(2021)
Slo akia
ABDA (2021b); Public Heal h Au ho i y o he Slo ak Republic (2021)
Slo enia
ABDA (2021b); Minis y o Heal h o Slo enia (2021)
Spain
ABDA (2021b); Spanish Minis y o Heal h (2021)
Sweden
Apo eks ö eningen (2021); Apo eks ö eningen (2025); Pha maceu ical
P icing and Reimbu semen In o ma ion (2007); Apo eke (2025);
Vogle e al. (2012)
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
44
Appendix 2: Sou ces o Da a
Table 7: Sou ces o Da a collec ion
Da a on Obse a ion
pe iod Sou ce
Pha macy densi y pe
100,000 inhabi an s 2000-2021
ABDA (2020); ABDA (2021); Vogle e
al. (2006); Vogle e al. (2012); Vogle e
al. (2014); PGEU (2020); Apo heke AB
(2023)
Sys em
( egula ed/libe al) 2000-2021
ABDA (2020); ABDA (2021); Vogle e
al. (2006); Vogle e al. (2012); Vogle e
al. (2014); Wo ld Heal h O ganiza ion
(2019); In e na ional Pha maceu ical
Fede a ion - FIP (2019)
RX mail-o de egula ion 2000-2021
ABDA (2020), ABDA (2021); Wo ld
Heal h O ganiza ion (2019); In e na ional
Pha maceu ical Fede a ion - FIP (2019)
Owne ship s uc u e 2000-2021
ABDA (2020); ABDA (2021); Vogle e
al. (2006); Vogle e al. (2012), Vogle e
al. (2014); Wo ld Heal h O ganiza ion
(2019); In e na ional Pha maceu ical
Fede a ion - FIP (2019)
Numbe o pha macies
in o al 2000-2021
ABDA (2020); ABDA (2021); Apo heke
AB (2023); S a is ics Poland (2023);
Wo ld Heal h O ganiza ion (2019);
In e na ional Pha maceu ical Fede a ion
- FIP (2019)
GDP pe capi a in PPP
(cons an 2017
in e na ional $)
2000-2021 Wo ld De elopmen Indica o s (2022)
Numbe o pha macis s
pe 100,000 inhabi an s 2000-2021 WHO Eu opean Da a Wa ehouse (2022)
P opo ion o popula ion
aged 65 and o e 2000-2021
Eu os a (2022); WHO Eu opean Da a
Wa ehouse (2022); In e na ional
Pha maceu ical Fede a ion - FIP (2019)
Geog aphic and
demog aphic ules 2000-2021
Vogle e al. (2006); Vogle e al. (2012);
Vogle e al. (2014); WHO (2019); Wo ld
Heal h O ganiza ion (2019); In e na ional
Pha maceu ical Fede a ion - FIP (2019)
Numbe o medical
doc o s pe 100,000
inhabi an s
2000-2021 Eu os a (2022)

i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
45
Appendix 3: Con ibu o y ac s and de ailed desc ip ion o he pha macy ma ke
o case s udy coun ies
The se en EU coun ies below ha e been chosen in o de o unde s and he
di e ences in pha macy ma ke s and hei egula ions depending on hei densi y.
This pa aims o demons a e he idea behind he hypo heses de eloped abo e.
As al eady discussed, he densi y o he chosen coun ies inc eased o e ime;
some e en s agna ed o did no consis en ly inc ease (see Figu e 1). Is his due
o a ma ke change ega ding he owne ship s uc u e o Rx mail-o de ? The case
s udy below cla i ies possible di e ences in densi y beha io conce ning di e en
ma ke egula ions.
Figu e 1: E olu ion o pha macy densi y35
Sweden
F om 1971 on, Swedish pha macies “we e exp op ia ed by law and amalgama ed
in o one na ional pha macy co po a ion owned by he s a e” (Balgå d, 2012, p.
23). “Apo eke AB” had a monopoly on d ugs un il 2009. The ma ke opened o
mo e compe i ion, and he s a e monopoly was ended (Wes e lund & Ma klund,
2020). The in en ion was o ge be e a ailabili y o he pha macies and lowe
p ices o OTC p oduc s (Balgå d, 2012). The idea was d i en by he igh -wing
35 This igu e only illus a es he se en selec ed case coun ies. Due o missing da a, he
obse a ion pe iod o Poland s a s in 2003.
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
46
pa y, which eplaced he social democ a ic pa y a e he elec ion in 2006. The
libe aliza ion o he pha macy ma ke included h ee main changes: ec ea ing
hospi al pha macies, open ma ke s uc u es, and he sale o OTC ou side he
pha macy. The idea behind he libe aliza ion policy was o ge be e accessibili y,
be e use o d ugs, mo e di e si y, and be e p ices and e iciency (Vogle e al.,
2014; Wisell, 2019). No ules we e se on owne ship. Ins ead, one pha macis
mus be p esen a all imes du ing o ice hou s. This pe son has o own a
Bachelo ’s deg ee ( h ee yea s, p esc ip ionis ) o a Mas e ’s deg ee ( i e yea s)
in Pha macy (Wes e lund & Ma klund, 2020).
Be o e he libe aliza ion, “Apo eke AB” owned o e 880 communi y pha macies.
A e he de egula ion, almos all exis ing pha macies we e sold o new chains,
and o e 200 new pha macies opened (Balgå d, 2012). In 2020, Sweden had
a ound 1,433 communi y pha macies, wi h 14 pha macies pe 100,000
inhabi an s (Wes e lund & Ma klund, 2020).
As al eady discussed, he libe aliza ion o he pha macy ma ke in ol ed many
expec a ions o imp o emen s such as be e accessibili y, lowe p ices, and
be e se ice (Vogle e al., 2012). Indeed, be e p ices o OTC we e a ailable,
bu no a he pha macy. The pha macies could no keep up wi h he p ices a gas
s a ions o d ugs o es because o highe pu chase cos s om he wholesale .
Fu he mo e, pha macies could eques he s ock in o he b anches h ough a
ne wo ked s o age sys em. Now ha each chain has i s own sys em, his access
is no longe possible (Balgå d, 2012). The libe aliza ion also emo ed he
dependency on “Apo eke AB’s” egula ions. Pha macies became ee o ope a e
wi hou he es ic ion o he la ge s a e-owned g oup. Now, 97 pe cen o he
communi y pha macies belong o chains, 45 independen pha macies, and “ h ee
unmi iga ed e-comme ce pha macy companies, ha a e aking medicine o de s
online only” (Wes e lund & Ma klund, 2020, p. 3). Fu he , OTC sale is possible
ou side he pha macy. The pick-up o dispensed p esc ip ions a pha macy
ep esen a i es, so-called “Apo eksombuds”, a e u he oppo uni ies o ge
medicine, especially in u al a eas (Vogle e al., 2012; Wes e lund & Ma klund,
2020).
The medical se ices p o ided in Swedish communi y pha macies a e ex ensi e:
medica ion e iews, blood measu e ea men s, skinca e analysis, alle gy es s,
smoking cessa ion p og ams, accina ion se ices wi h he help o nu ses, and
much mo e. Wes e lund and Ma klund (2020) explain ha chains ocus mo e on
selling medicines, whe eas p i a e pha macies concen a e mo e on ex ended
se ices like medica ion plans. In hei iew, he eason is ha chains ha e o
compe e mo e in he sale o medicines han p i a e pha macies. Thus p i a e
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
47
pha macies can be e main ain hei posi ion in he ma ke by o e ing mo e
se ices (Wes e lund & Ma klund, 2020).
Sweden was one o he i s EU coun ies ha implemen ed digi al p esc ibing.
Almos all p esc ip ions a e digi al, and pa ien s can access hei da a wi h hei
pe sonal iden i ica ion (ID) ca d (Kie kegaa d, 2013; Vogle e al., 2012). Online
sales o OTC s a ed in 2002, and Rx mail-o de in 2006.36 Since 2009, he online
sale o medicines by in e ne pha macies o he han “Apo eke AB” has been
allowed as well (Vogle e al., 2012). OTC p ices, compa ed o p esc ip ion only
medicines (POM), a e no egula ed; he e o e, pha macies sell mo e OTC
p oduc s. Fu he , communi y pha macies canno p oduce medicine, o example,
in Ge many o Aus ia. They do no ha e a labo a o y37 o do so (Vogle e al.,
2012).
Following Wes e lund and Ma klund (2020), he eimbu semen 38 sys em is
mixed. I “is based on a Pha macy Ma gin, wi h a combina ion o ixed ee and
pe cen age” (Wes e lund & Ma klund, 2020, p. 4). Discoun s on gene ic d ugs
a e allowed bu no on “p ima y ca e se ices” (Wes e lund & Ma klund, 2020,
p. 4). Howe e , gene ic subs i u ions a e eimbu sed “wi h an inc eased ma gin
added o all gene ic d ugs” (Wes e lund & Ma klund, 2020, p. 4).
The libe aliza ion p ocess inc eased he numbe o communi y pha macies
ac oss Sweden. O cou se, he densi y is much highe in u ban a eas. The e o e
so-called “Apo eksombuds” exis o co e u al a eas. Fu he , wi h a high
digi aliza ion s anda d and ex ended se ices wi hin he pha macy, he densi y
emains s able – e en wi h Rx mail-o de . Howe e , he main goal o be e
accessibili y h oughou he coun y could no be achie ed (Ga a ini e al., 2012;
Vogle e al., 2014; Wisell, 2019).
36 Only wi hin he coun y, no om ab oad.
37 A labo a o y a he pha macy is used by pha maceu ical s a , o example, o es
exis ing anes he ics o any impu i ies and o p epa e oin men s o capsules specially
p esc ibed by a doc o . Fu he mo e, pha maceu ical s a can mix unique p esc ibed
ea la o s and p oduce disin ec an s.
38 By de ini ion: “Pha macy eimbu semen means he amoun paid o a pha macy by a
pha macy bene i manage o a dispensed p esc ip ion d ug o p esc ip ion de ice”
(Law Inside Inc., 2022).
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
48
Denma k
The Danish pha macy ma ke is a egula ed one. Only licensed pha macis s,
accep ed by he Danish Medicines Agency (DKMA), can un and own a
pha macy. The DKMA u he limi s he numbe o pha macies and gi es an
e alua ion o applican s o he Minis y o Heal h. They hen decide who will ge
he license o a pha macy (Vogle e al., 2012).
Pha macies, b anch pha macies, and supplemen a y uni s a e he ins i u ions
wi h he igh o sell Rx and some speci ic OTC p oduc s (Vogle e al., 2012). In
addi ion o he 227 pha macies (1 Janua y 2021), “80 b anch pha macies, 209
olun a ily es ablished b anches, 24 pha macy ou le s, abou 350 OTC ou le s
and abou 400 medicine deli e y acili ies – all o which a e connec ed o one o
he pha macies” (Danish Medicines Agency, 2021) exis s. OTC ou le s a e s o es
app o ed o sell OTC p oduc s ou side he pha macy, o example, supe ma ke s.
They a e u he allowed o “deli e p esc ip ion-only medicinal p oduc s ha ha e
been dispa ched by a pha macy o he ou le ” (Danish Medicines Agency, 2021).
In addi ion, buying POM online is pa ly p ohibi ed. The only excep ion is he
pla o m called “Apo eke .dk”. Since 2004, i has been he only online pha macy
wi h he igh o sell POM online. I is an online pla o m o all pha macies in
Denma k ini ia ed by he Danish pha macy ep esen a i e (Kie kegaa d, 2013).
The densi y o Danish pha macies a ies o e ime. No ewo hy is ha in 2015,
he densi y inc eased because Denma k allowed e e y owne o communi y
pha macies o open up o se en b anches wi hin a adius o 75 kilome e s
(Danish Medicines Agency, 2021). The change in he Danish Pha macy Ac
should inc ease he accessibili y o communi y pha macies o he pa ien – wi h
success.
To make he owne ship o pha macies in u al a eas mo e a ac i e, he e a e
so-called equaliza ion schemes: “Pha macies wi h la ge u no e a e obliged o
pay a sales ax, which is used o subsidise small scale pha macies in u al a eas”
(Vogle e al., 2012, p. 101).39 The Danish pha macies ha e o pay special ees
o he DKMA (Danish Medicines Agency, 2021).
The e is no obliga ion o a 24-hou se ice – bu he e is a sys em specially
o ganized by au ho i ies. Some pha macies mus s ay open h oughou he nigh ;
o he s ha e on-call du y se ices. The e a e h ee di e en ca ego ies:
39 Likewise in Ge many wi h he “Nach -und No diens ond” (NNF).
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
55
Pha macies in Aus ia ha e o adap hei opening hou s o he local shops. The
pha macies p o ide eme gency and nigh se ices, no inanced by a special und
as in Ge many (NNF), bu by he pha macies hemsel es.
The wholesale s se p ices o d ugs. Following BWB (2018), eimbu sable
medicines43 canno be discoun ed, whe eas a discoun can be gua an eed on
non- eimbu sable medica ions.
Fu he , pha macies can se hei p ice on non- e undable d ugs, so he
compe i ion s a s. Pha macies in Aus ia deli e medicines, gi e heal h ad ice,
and check on no able side e ec s. The s a can accina e agains se e al
pa hogens and p o ide heal h-ca e suppo abou smoking, blood suga ,
choles e ol, and many mo e (Lange e al., 2018).
Despi e he egula ed ma ke , he densi y o Aus ia’s communi y pha macies has
isen. Due o he so-called “Gebie sschu z”, he e is no di ec local compe i ion.
Wi hou Rx mail-o de wi hin he coun y bu dispensing doc o s ha ing he igh
o sell medicine in u al a eas, he accessibili y o POM and OTC is ensu ed
(Ös e eichische Apo heke kamme , 2022).
Ge many
A e many yea s o g ow h, he densi y o communi y pha macies in Ge many
has declined since 2008. The Ge man case migh be challenging because o he
hyb id pha macy ma ke , o eign mail-o de disad an ages o communi y
pha macies, and many bu eauc a ic hu dles wi hin he business (Schwaabe,
2020). In ecen yea s, he e ec s o egula o y implemen a ions o he Ge man
communi y pha macies ha e led o he so-called “Apo hekens e ben” – a decline
in he numbe o densi y o communi y pha macies. Due o he Ge man
euni ica ion, he numbe o pha macies inc eased signi ican ly. Posi i e e ec s
we e also eco ded a e he ban on mul iple and hi d-pa y owne ship. Howe e ,
hese we e decep i e, as pha macies we e bough up. Since 2008, he o al
numbe o pha macies in Ge many has dec eased con inuously om 21,602
pha macies o 18,461 pha macies in 2021 and 18,256 in mid-2022 (Tagesschau,
2022).
Some a icles epea edly e e o he compe i i e ad an ages o o eign mail-o de
pha macies (“ausländische Ve sandhandelsapo heken”) (Coenen e al., 2011;
May e al., 2017; Meye , 2020). The g an ing o discoun s on p esc ip ion d ugs
43 Reimbu sable medicines a e co e ed by heal h insu ance.

i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
56
by o eign mail-o de pha macies, he esul ing compe i i e ad an age o e
Ge man pha macies, he “Meh - und F emdbesi z e bo ” and he e-p esc ip ion
could be possible causes o a decline in pha macy densi y. Ne e heless, he
Ge man pha macies a e a a disad an age due o he Ge man p ice egula ion
o p esc ip ion d ugs (“AMP eisV”), which binds pha macies o ixed p ices when
selling Rx. Thus, no discoun s will be applicable. This means ha he
pha maceu ical indus y se s a p ice wi h he insu ance on one ac i e subs ance.
Publicly insu ed people ha e o pay a so-called “Eigenan eil”. This is obliga ed.
Online pha macies om ab oad can gi e a discoun on his “Eigenan eil”.
The ixed d ug p ices in Ge many a e in ended o ensu e ha local Ge man
pha macies can p o ide comp ehensi e medical ca e o he same p ice. In 2016,
his app oach was c i icized by he Eu opean Cou o Jus ice (ECJ) as i could
no be adequa ely jus i ied. The ECJ no ed ha binding consigno s om ab oad
o he Ge man “AMP eisV” iola es Eu opean law. P ice- ixing cons i u es an
unjus i ied es ic ion on he ee mo emen o goods in he sense o a quan i a i e
impo es ic ion. The e o e, he ixed p ices in Ge many a e o Ge man
pha macies bu no o eign (mail-o de ) pha macies. The “DocMo is”44 decision
in 2003 opened he mail-o de ma ke o non-POM and OTC p oduc s (Jo ge,
2016). Ge many wen one way u he and opened he mail-o de ma ke o POM
wi h hei “Mode nisie ungsgese z” in 2004. In 2021, he pha macis s’ lobby
abolished discoun s o Rx ab oad a e leng hy legal ba les be ween se e al
Ge man communi y pha macies and “DocMo is”. Howe e , his applies o
pa ien s wi h s a u o y insu ance only. P i a ely insu ed pa ien s con inue o
ecei e a discoun (Roh e , 2021).
In addi ion, OTC sale is pe mi ed ou side he pha macy wi hin d ugs o es o
supe ma ke s. Only licensed pha macis s wi h a so-called “App oba ion” can un
and own a pha macy in Ge many. No chains a e allowed, only so-called
“Einkau sgenossenscha en”45 (“Gu en Tag Apo heken”, “mea Apo heken”, and
many mo e).
Ano he ema k is ha Ge man pha macis s a e egis e ed ade s. This means
ha he pha macy owne is liable o hei asse s. The a e age ne u no e o a
pha macy in Ge many is abou 2.78 million eu os pe yea . Howe e , he e is a
44 “DocMo is”, an online pha macy loca ed in he Ne he lands, is a Swiss “Zu RoseAG”
subsidia y. I is he mos p ominen online pha macy p o ide in Eu ope.
45 Smalle pha macies uni e o o m a coope a i e o buy as a mo e signi ican cus ome
om he wholesale s o he companies hemsel es and hus ge be e discoun s on
he pu chase p ice.
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
57
as sp ead. A ound 60 pe cen o pha macies do no achie e he a e age
u no e , while indi idual la ge pha macies a e a abo e he a e age.
In he end, pha macies need a ic. They should be loca ed nex o a p esc ibing
doc o , wi hin shopping cen e s, o on shopping s ee s (Elabed e al., 2016;
Ös e eichische Apo heke kamme , 2022). In o he EU coun ies, i is manda o y
o ha e a dispending doc o close o he pha macy (Ös e eichische
Apo heke kamme , 2022). Al hough he Ge man pha macy ma ke is egula ed,
eedom o es ablishmen p e ails. The e o e, he compe i ion is inc easing,
ha ing pha macies close o each o he . The pha macy wi h he bes o e s and
u he se ices su i es. Pha macies in Ge many o e he same se ices as in
Aus ia excep o he accina ion se ice. Since 2022, Ge man pha macis s ha e
been allowed o accina e agains Co id-19 bu no agains in luenza (ABDA,
2022).
In sum, he densi y o pha macies in Ge many dec eased because o he eedom
o es ablishmen , he Rx mail-o de , i s discoun s, and he missing digi aliza ion.
Due o new laws ha allow pha macies o accina e (only) agains COVID-19
since Feb ua y 2022 and he ban on discoun s on Rx ab oad, s abili y o he
densi y could be expec ed. Ne e heless, he digi aliza ion p ocess, which is
much mo e de eloped in o he EU coun ies and has become an essen ial pa
o e e yday pha macy li e, lacks behind.
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
58
Appendix 4: Ou look on pha macy densi y in Ge many
Ge many has seen a decline in i s pha macy densi y, dec easing om 21,592
communi y pha macies o 17,571 wi hin he las 23 yea s. In 2023, he e we e
599 closu es compa ed o 62 new openings, leading o app oxima ely 21
pha macies pe 100,000 inhabi an s – a igu e ha has been g adually declining
(ABDA, 2024).
Acco ding o he ABDA (2024) “Zahlen, Da en, Fak en” epo , his end is
in luenced by a ious ac o s, including economic p essu es, demog aphic shi s,
and egula o y challenges. The epo no es he inancial s ain on pha macies,
pa icula ly independen ones, due o ising ope a ional cos s and lowe
eimbu semen a es o medica ions. Addi ionally, he g owing p esence o mail-
o de pha macies is changing consume beha io , wi h mo e pa ien s op ing o
online se ices, which has impac ed he oo a ic in adi ional pha macies.
This end is consis en wi h b oade de elopmen s obse ed in o he Eu opean
coun ies. Fo ins ance, om 2004 o 2023, Belgium’s pha macy densi y
dec eased om 50 o 40 pha macies pe 100,000 inhabi an s, while Aus ia
expe ienced a sligh inc ease om 14 o 16 pe 100,000 inhabi an s. These
changes e lec ongoing shi s wi hin he Eu opean pha macy sec o (ABDA,
2024).
The indings o his s udy sugges ha ma ke egula ions, such as owne ship
es ic ions and bans on Rx mail-o de se ices, do no signi ican ly con ibu e o
an inc ease in pha macy densi y in Ge many. Ins ead, he ocus may need o shi
owa ds imp o ing he a ailabili y and e ec i e placemen o pha macis s. The
ABDA (2024) epo emphasizes he impo ance o e aining and ec ui ing
pha macis s, pa icula ly in u al a eas, whe e pha macy closu es can ha e a
mo e p onounced impac on heal hca e accessibili y, oo.
Policymake s may conside in e en ions such as inancial incen i es o
pha macis s in unde se ed a eas, suppo o small and independen
pha macies, and po en ial adjus men s o he egula o y amewo k o be e
suppo pha macy ope a ions. These measu es could help s abilize pha macy
densi y in Ge many and ensu e con inued access o p o essional heal hca e
se ices o all ci izens.
In he coming yea s, bo h policymake s and pha macies in Ge many will need o
conside how many pha macies pe 100,000 inhabi an s a e necessa y o he
coun y. I will be impo an o e alua e whe he app oxima ely 22 pha macies pe
100,000 inhabi an s we e excessi e and i his le el o compe i ion was
i gs Sch i en eihe, Vol. 32, Schwaabe.: The EU Communi y Pha macy Ma ke
59
sus ainable. Addi ionally, he e may be a need o assess whe he Ge many
equi es demog aphic o geog aphic egula ions o pha macies, po en ially
mo ing away om he cu en sys em o ee es ablishmen . Fu he mo e, he
issue o ec ui ing new licensed pha macis s should be add essed in poli ical
discussions. Financial incen i es could be conside ed o encou age mo e
indi iduals o pu sue ca ee s in pha macies. Howe e , his s udy highligh s ha
changes in he pha macy ma ke should no be au oma ically adop ed om o he
coun ies. Policies ha ha e been e ec i e in o he EU na ions may no
necessa ily p oduce he same ou comes in he Ge man pha macy ma ke .
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ISBN (eBook) 978-3-89275-183-0 – ISSN (eBook) 2569-527
Band 24 (2021)
Elsenheime , Lau a / Beh ens, Y onne / Wiesene , Ma c / Kan e mann, Thomas
Resea ch Ne wo k In e na ional: Von Wissenscha , Ve ne zung und Emo ionen
ISBN (P in ) 978-3-89275-230-1 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-231-8 – ISSN (eBook) 2569-5274
Band 25 (2022)
Schä e , S e anie / Scha , A nd
Nachhal iges be iebliches Gesundhei smanagemen im Handwe k
ISBN (P in ) 978-3-89275-246-2 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-247-9 – ISSN (eBook) 2569-5274
Band 26 (2022)
Hein, Ka ha ina Anna-Ch is ina
Selbs bes imm es S e ben – Au onomie und Menschenwü de am Lebensende
ISBN (P in ) 978-3-89275-258-5 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-259-2 – ISSN (eBook) 2569-5274
Band 27 (2022)
Beh ens, Y onne / Mache , Sand a / Kollányi, Zsó ia / Mo ales Mo eno, Isabel /
Il che , Velko / Romaniuk, Pio / Alce , Klaudia / Kaczma ek, K zys o / B ukało,
Ka a zyna / Mo ales He nández, Ca alina / Palacios Ramí ez, José / Fe ándiz
Gomis, Robe o / López A oyo, Ma ía José / Ranche , Nikola / Amo , F ank M. /
Kös e s, Ines
Compe ences in Heal h Ne wo k Managemen – A Tex book o T aining
Regional Heal h Ne wo k Manage s
ISBN (P in ) 978-3-89275-280-6 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-281-3 – ISSN (eBook) 2569-5274
Band 28 (2023)
Scha , A nd / Olb ech , Thomas / Mage l, Niklas / Con ads, Tom / Loch, Fabian /
Wol , Anna / S o ch, Fabian / Schul z, S e an / Paus , Robe / Weiß, Susanne
Be iebliches Gesundhei smanagemen – Key Lea nings aus he aus o de nden
BGM-P ojek en
ISBN (P in ) 978-3-89275-314-8 – ISSN (P in ) 2367-3176
ISBN (eBook) 978-3-89275-315-5 – ISSN (eBook) 2569-5274
Band 29 (2024)
Beh ens, Y onne / Mo ia, Madlene / Mache , Sand a / Amo , F ank
Success ul Managemen o Heal h Regions – Ci cums ances, Challenges and
Compe ences in Ge man Heal h Regions
ISSN (P in ) 2367-3176 – ISSN (eBook) 2569-5274
ISBN (P in ) 978-3-89275-368-1 – ISBN (eBook) 978-3-89275-369-8
Band 30 (2024)
Holzkämpe , Hilko
Auswi kungen de Co ona-Pandemie au die wi scha liche Si ua ion on
P legeheimen
ISSN (P in ) 2367-3176 – ISSN (eBook) 2569-5274
ISBN (P in ) 978-3-89275-366-7 – ISBN (eBook)978-3-89275-367-4
Band 31 (2024)
Beh ens, Y onne / Biele , Ka h in / Kelle , Ka in / Busskamp, Ma een / Eile s,
Leonie / Shku a, Oleksand / K on, Flo ian / Henn ich, Inga / F iebe, Michael /
Hoho , Ch is oph
Bildung und Quali izie ung im Gesundhei swesen: Ein Einblick in die P ojek e de
FOM Hochschule
ISSN (P in ) 2367-3176 – ISSN (eBook) 2569-5274
ISBN (P in ) 978-3-89275-358-2 – ISBN (eBook) 978-3-89275-359-9