Latent social functions of the health care institute: a case of pharmacies in Russia
The paper aims to portray and to discuss the informal impact of drugstores on health in Russia today, taking into account their formal role in the health care system. The empirical study was conducted in 2013 in the Perm region. It was a part of the larger project on description of all informal providers of goods and services for self-treatment in Russia.
According to our suggestion, if the pharmacies are commercial organizations, they inevitably adapt their work to customers’ demands. As a result, the tasks not designated by state policy are taking a prominent place in their work. In the terminology of R. Merton it could be called the latent (hidden) functions, i.e. unintentional and unconscious consequences of their activities. In order to describe them, we analysed the legislation and general statistics of drug sales in Russia, conducted 30 in-depth interviews with pharmacists, inspected around 50 pharmacies in different towns and villages, and specially registered all customers’ demands during two days in one pharmacy.
The peculiarities of the healthcare system and pharmaceutical retail in Russia may create conditions for a high level of self-medication and the proactive role of pharmacies in it. Nevertheless, in the Russian legislation the main reason for the existence of pharmacies is to provide remedies which are prescribed by doctors. It seems to mirror the classical, paternalistic model of health care. The legislative framework leads to the conservation of the hidden social functions of pharmacies, because deviations are widespread although illegal.
In sum, the empirical research demonstrates three main latent functions of pharmacies: to take on the duty of physician, to provide remedies for self-medication (whether conventional OTC and prescription medicines or food supplements, or alternative medicine), to serve addicted people and to help them in maintaining a destructive dependence. Each of them reveals in the various aspects of communications and implicit behavior rules in pharmacy. All of them work against formal healthcare.