OBJECTIVES: Former socialist countries’ transitions to market economy have had significant implications for health service policy and delivery. This study uses the transition in Macedonia as a case study setting to explore how such changes have been perceived to impact prescribing and supply of medicines. This study focuses on key primarycare policies relating to prescribing volume limitations and dispensing policy enforcement. Study aimed to explore experiences and perceptions of how privatisation and regulation policies influenced the medicine prescribing and dispensing from the perspectives of primary care physicians, pharmacists, patients and elite stakeholders.

METHODS: Qualitative design was used utilising semi-structured interviews with a purposive and snowball sample of 17 doctors, 12 pharmacists, 14 patients and 12 elites. Face-to-face interviews were recorded, transcribed and analysed using thematic analysis approach.

RESULTS: Differing perspectives emerged, with primary care physicians and pharmacists feeling pressure from both regulatory bodies and patients qua their expectations and medicines demands. They felt detached from policies and that guidance was lacking. Disempowerment and threats to professional autonomy resulted, with unethical implications for irrational prescribing and supplying medicines without prescriptions. Elites considered policy changes as necessary although they, and other participants, made comparisons to the previous system which was viewed with nostalgia, as being fairer. Patients reported new pressures in negotiating medicine supply, justifying self-medication practices. Lack of coherent policy implementation was a recurring theme.

CONCLUSIONS: Increasing regulation, marginalised professionals and patients led to numerous diverse experiences. Using a Habermasian perspective, policy changes within Macedonia reflect a system that threatens individuals' lifeworlds; new policies represent juridification and professionals’ perception of being isolated, uninvolved and unsupported, reflecting disruption of communicative acts and justice. This study suggests the need to improve communication between different stakeholders and involve practitioners and patients to ensure policy change is sensitive, and not a threat, to individuals' autonomy.