Samskara:

There is a similar pattern in pharmacies, where the need for productivity reduces or even eliminates pharmacist-patient contact. In order to keep costs down, technicians take in, fill, and even do the actual dispensing. The pharmacist, who should be speaking to the patient, reviewing use of over-the-counter medications, discussing the proper way to take medications, is reduced to checking the technicians' work against the prescription.

The last time I looked, pharmacies were being paid by insurers the "average wholesale cost" of the drug (as determined by folks who are paid by the insurers to estimate this, not their actual cost) plus about $3.50 per prescription for the labor. Since then, of course, the payment for labor has changed; I believe it's gone down. Note that Medicare has been in the forefront of pushing down these payments, so you can't blame it all on greed for profits.

So, goodbye mom and pop pharmacies, hello big chains where the pharmacy is just a lure to get you in the store to buy something profitable.

And hello mailorder pharmacies.

However, note again that in Canada, universal drug coverage does not follow from universal medical coverage; it depends on the fiscal health and generosity of each province's healthplan. They try to fix that by capping drug prices, of course.

Besides that, I do believe this article glosses over the problem of prescription noncompliance because of cost. Most of the prescriptions go to the elderly, who are on "fixed incomes". Copays can be pretty high even when there is coverage. I myself, who am not elderly nor on fixed income, am noncompliant with expensive meds to a degree that would have shocked me a few years ago when I was researching this question. Just because Swedes' behavior isn't affected by their costs, doesn't necessarily extend to Americans.

However, there is a lot of research going on right now on whether copays affect compliance, and how that does or doesn't pay off in terms of better health, and, eventually, lower medical costs.