What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states

Datos Bibliográficos

ID11492020
AutoresKay Sheikh (0000-0003-4755-2075, Public Health Foundation of India, autor de correspondencia), Kabir Sheikh, Prasanna S Saligram, Prasanna Saligram (Public Health Foundation of India), Kris Hort (0000-0002-3843-3923, Public Health Foundation of India), Krishna Hort
Año2015
Volumen30
Número1
Páginas39-55
Fecha de publicación2015-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czt095
PMID24342742
OpenAlexW2117446516
IdiomaEN
Citas recibidas25
Referencias citadas24

Regulating health care is a pre-eminent policy challenge in many low- and middle-income countries (LMIC), particularly those with a strong private health sector. Yet, the regulatory approaches instituted in these countries have often been reported to be ineffective-India being exemplary. There is limited empirical research on the architecture and processes of health care regulation in LMIC that would explain these regulatory failures. We undertook a research study in two Indian states, with the aims of (1) mapping the organizations engaged with, and the written policies focused on health care regulation, (2) identifying gaps in the design and implementation of policies for health care regulation and (3) investigating underlying reasons for the identified gaps. We adopted a stepped research approach and applied a framework of basic regulatory functions for health care, to assess prevailing gaps in policy design and implementation. Qualitative research methods were employed including in-depth interviews with 32 representatives of regulatory organizations and document review. Several gaps in policy design were observed across both states, with a number of basic regulatory functions not underwritten in law, nor assigned to a regulatory organization to enact. In some instances the contents of regulatory policies had been weakened or diluted, rendering them less effective. Implementation gaps were also extensively reported in both states. Regulatory gaps were underpinned by human resource constraints, ambivalence in the roles of regulatory organizations, ineffective co-ordination between regulatory groups and extensive contestation of regulatory policies by private stakeholders. The findings are instructive that prevailing arrangements for health care regulation are ill equipped to enact several basic functions, and further that the performance of regulatory organizations is subject to pressures and distortions similar to those characterizing the wider health system. This suggests that attempts to strengthen health care regulation will be ineffectual unless underlying governance failures are addressed.

Business · Economic growth · Economics · Health care · Political science · Public economics · Public relations · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms · Public Administration · Health Policy