COURSE: INTERNATIONAL
HEALTH/HEALTH MANAGEMENT AND POLICY.
Regulation is the one of the control knobs in which
government or an organization uses to bring about positive change. Regulation
is the faith control knobs in health reformation. It is simply said to be the
coercive use of power to change the behaviour of people and their organization
of work as well.
The coercive use of power involves
full range of legal instruments (laws, decrees, orders, code, administrative
rules and guidelines) whether issued by government or non government bodies who
have been given regulatory power.
Regulation
on the other hand can said to be rule or directive made and maintained by
people and the organization.
Roles Played by Regulations (Reasons for
Regulations)
Just as the economist view
government as using market to allocate resources so also is regulation used to
control patterns and distribution of services.
Government
that want to make its’ market uses regulations to establish rules governing
properties and rights and to guarantee that there will be honest and open
exchange. In absence of such regulations, the most manipulative and powerful
will take all (Oaskeshou 1975).
Using this role in health
reformation, government uses regulation to establish an obligation and
responsibilities of both buyers (Patients and consumers) and the sellers
(doctors, pharmacies, hospitals and insurers) to ensure that the agreed
transaction are honest, transparent and reliably executed.
* Regulation is used in situations where
market is successful but the distribution of the well being they produce is not
acceptable due to ethical frame-work. Regulation, is then used to achieve a
more equitable out come e.g in situations where ordinarily, doctors and other
health worker would prefer to work in urban areas because of availability of recreational
infrastructures and also increased chances of improving their economic statue.
Since
they deal with richer patients in cities that can afford their prices they may
limit their services in this urban areas neglecting the poorer ones in rural region to suffer from their
chronic health conditions. This invariable result to increase mortality and
morbidity. This result by law of equity is very objectional. Here regulate is
used to correct such imbalance by making provision with rules to ensure equal distribution of
goods and services. Medical students and nurses after their graduation are
posted to work in various part of the health sector to ensure equal
distribution of goods and service.
* Government use regulation to improve
the functions of some market that does not do well on their own (Heriot 1997)
Patients may be unable to judge quality of goods and services they are getting.
This now put them at risk and they may, because of their ignorance be
victimized by unqualified doctors and other health personnel. In a situation
like this regulation is used to control this gap of marketers by;
(1) Providing adequate information’s to the
buyers.
(2) Improved labeling of the market
(3) Restricting of what is in the market by
licencing doctors
(4) Restriction of the drugs that can be
sold.
(5) Reducing number of physicians and number
of hospital beds.
* Another
market failure where regulation can be applied is on control monopoly.
Regulation is used to control monopoly through
(1) Fixing price by the agency
(2) Limiting the idea and practices of
merging different companies into one. This reduces the competitive power in
market and thus creating room for monopoly. Regulation tries its possible best
to see that such does not develop. Competition lowers down cost so that every
body can afford it. (ie cost of hospital services).
* Government uses regulation to advance
moral norms such as sanctioning drug trafficers, - banning use of cocaine by
individual for addict (this has adverse effect on health).
Also
government uses regulation to quarantine greedy HIV patients engaged on unsaved
sex.
Here
government uses regulations to control and limit transactions that offend moral
sensibility e.g criminal abortion.
Just as regulation plays a
significant role in market sinerior, so also is it applicable to health sector.
With all this major roles which can be achieved through regulation, regulation
is therefore a major activity in health system and a major control knob for
improving health system reformation. Therefore, for other control knobs to be
effective, they must be accomplished by appropriate regulations.
Regulation is more effective when
there is appropriate incentives and efforts to influence behaviour (Lafiont and
Tirole 1993).
Regulation is not self implementing,
it requires both the administrative and political task for it to be effective.
Hence a poorly designed regulation can worsen condition of an organization and
vise visa.
Determinant of Regulation Success
Strategies need to be applied to
achieve an appropriate regulation.
This
includes: Making decision and about what and how this decision is going to be
regulated.
Å Establishment
of the agencies.
The regulatory agencies have to be establishing with
different categories of people to mind its affairs.
Å Detailed
rules have to be written and these rules have to be applied to specific cases.
Å Monitoring
process need to be established so that violators can be identified and either persuades
to change their behaviour or penalized if they don’t.
Å Other factor
includes cultural attitudes of the people, government competence and political
supports.
Å Culture: People are influenced by their
different belief and norms. Specific cultural belief and norms influences the
effectiveness of regulation. Citizens comply easily to rules and regulation
that is compatible with their social believes and culture.
Å Compliance of the Government and its Capacity
Regulation is better achieve when
government involves experts in the different field to seat and take division to
bring a lasting solution to any problem. People also accept rules and
regulations when there is sincerity on the part of government. The people have
confidence and belief that this rules are for their own betterment. With such
confinement, regulation formation is usually more successful. Also regulation
is better achieve in a situation where there is high quality civil service, well
functioning police, good court systems, effective tax reporting etc.
In
summary, an effective regulation requires combination of technical experts,
administrative capacity and political support.
MAJOR TYPES OF REGULATIONS IN HEALTH
SECTOR
Three
important area of regulation related to health systems care :-
1. Regulations
of the producers of inputs to health system including educational institutions.
2. Provider
licensure, manufacture of pharmaceuticals medical equipments, health care
delivery including both hospital and non hospital providers.
3. Regulation of health insurance.