Original Paper

Health Care Analysis

, Volume 19, Issue 4, pp 352-364

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Public Accountability and Sunshine Healthcare Regulation

  • Rui NunesAffiliated withFaculty of Medicine of the University of Porto (Portugal-EU) Email author 
  • , Cristina BrandãoAffiliated withFaculty of Medicine of the University of Porto (Portugal-EU)
  • , Guilhermina RegoAffiliated withFaculty of Medicine of the University of Porto (Portugal-EU)


The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of the different agents, to avoid quality shading problems and for healthy competition in this sector. Methodologically, the authors depart from Kieran Walshe’s regulatory theory that foresees healthcare regulation as an instrument of performance improvement and they articulate this theory with the different regulatory strategies. The authors conclude that sunshine regulation takes on a special relevance as, by promoting publicity of the performance indicators, it contributes directly and indirectly to an overall improvement of the healthcare services, namely in countries were citizens are more critical with regard to the overall performance of the system. Indeed, sunshine regulation contributes to the achievement of high levels of transparency, which are fundamental to overcoming some of the market failures that are inevitable in the transformation of a vertical and integrated public system into a decentralised network where entrepreneurialism appears to be the predominant culture.


Accountability Healthcare regulation Independent regulatory agencies Sunshine regulation