From community pharmacies to big pharmacy chains: private provision of medicines, health system, and financialization of the Brazilian retail pharmacy market

The provision of medicines in Brazil is marked by the predominance of private expenditures and supply in pharmacies and by the historically liberal regulation of retail drug sales. The first two decades of the 21st century witnessed the expansion and concentration of the retail pharmaceutical sector and growing financialization of the health sector. The article analyzes the characteristics of financialization of Brazilian retail pharmaceutical companies, considering the following three crosscutting dimensions: ownership structure, financial/accounting, and political. Quantitative and qualitative data from various sources were analyzed including ownsership and account informations of the ten biggest Brazilian retail pharmacies chains and political action of four business associations. The information collected was stored in the source project database. The ownership structure dimension revealed verticalization, diversification, capitalization via financial and shareholding operations, intensification of mergers and acquisitions, opening of pharmacy branches, entry of investors, and changes in internal management and organization. The financial/accounting dimension revealed an increase in size (revenues, assets, net worth) and good performance (return on equity capital, capital turnover, and third-party capital) of the networks compared to Brazilian companies and health companies. The policy arena revealed both clashes and collaborations between representative associations and government (Executive, Legislative, and Judiciary), depending on the issue, with outcomes that were generally favorable to the pharmaceutical sector and leadership by the Brazilian Association of Pharmacy and Drugstore Networks (Abrafarma). The financialization of the retail pharmaceutical companies’ accumulation pattern and the strengthening of their political action proved relevant for understanding the changes in the provision of medicines and in the pharmaceutical market.

巴西药品供应领域长期以来以私人支出与药店供给占主导、且零售药品销售监管历来宽松为显著特征。21世纪头二十年，巴西零售制药行业实现扩张与集中化，同时卫生领域的金融化程度不断加深。本研究针对巴西零售制药企业的金融化特征展开分析，重点考量三大贯穿性维度：所有权结构、财务/会计维度与政治维度。研究整合多源定量与定性数据进行分析，涵盖巴西十大零售药店连锁机构的所有权与会计信息，以及四家行业协会的政治行动相关内容。所采集的信息均已存入本项目的源数据库中。所有权结构维度显示出如下特征：纵向整合程度加深、业务多元化发展、通过金融与持股运作实现资本化、并购活动愈发频繁、药店门店持续扩张、投资者纷纷入局，以及内部管理与组织架构发生变革。财务/会计维度显示，相较于巴西本土企业与卫生领域其他企业，该连锁体系的规模（营收、资产、净资产）持续扩张，且盈利表现优异，具体体现为净资产收益率、资本周转率及第三方资本利用率均处于较高水平。政策层面的分析显示，行业代表协会与政府（行政、立法及司法部门）之间根据议题不同，既存在冲突也不乏合作，最终政策结果总体上有利于制药行业，且巴西药店与药房连锁协会（Abrafarma）占据主导地位。零售制药企业的金融化积累模式及其政治影响力的增强，对于理解巴西药品供应与医药市场的变革具有重要意义。