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.

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.
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