Health Care Analysis

, Volume 15, Issue 3, pp 169–177 | Cite as

The Rise of Independent Regulation in Health Care

Original Article

Abstract

In all countries where health care access is considered a social right, regulation is both a tool of performance improvement as well as an instrument of social justice. Both social (equity in access) and economical (promoting competition) regulation are at stake due to the nature of the good itself. Different modalities of regulation do exist and usually new regulatory cycles include the creation of stronger regulatory agencies. Indeed, health care regulation is rising steadily in most developed countries as a consequence of the introduction of the New Public Management perspective to provide essential public goods.

Health care is delivered by different organisations with very different cultural backgrounds—public and private (profit and non-profit)—that should be accountable for their decisions. Control by regulatory agencies is instrumental to accomplish this goal. However, there is some dispute with regards the degree of regulatory autonomy. The objective of this paper is to determine if independent regulatory agencies (IRAs) are effective in carrying out health care regulation. The authors apply Walshe’s analytical framework to the Regulatory Authority of Health (Portugal) to answer the question if independent regulation works.

In conclusion, the two year experience of the Regulatory Authority of Health is important not only because the primary goals of independent regulation were achieved but also because this authority is now a full partner in the health care sector. However, independent agencies need to develop strong mechanisms of accountability because good regulatory governance is the paradigm of this institutional innovation.

Keywords

Economic regulation Governance Health care regulation Independent regulatory agencies Social regulation 

References

  1. 1.
    Ayres I, Braithwaite J (1992) Responsive regulation. Transcending the deregulation debate. Oxford University Press, OxfordGoogle Scholar
  2. 2.
    Baldwin R, Cave M (1999) Understanding regulation. Theory, strategy and practice. Oxford University Press, OxfordGoogle Scholar
  3. 3.
    Boyer R, Saillard Y (2002) Regulation theory. The state of the art. Routledge, LondonGoogle Scholar
  4. 4.
    Colley J, Doyle J, Logan G, Stettinius W (2003) Corporate governance. The McGraw-Hill Executive MBA Series, LondonGoogle Scholar
  5. 5.
    Crew M (1999) Regulation under increasing competition. Kluwer Academic Publishers, BostonGoogle Scholar
  6. 6.
    Daniels N, Light D, Caplan R (1996) Benchmarks of fairness for health care reform. Oxford University Press, New YorkGoogle Scholar
  7. 7.
    Daniels N, Sabin J (2002) Setting limits fairly. Oxford University Press, New YorkGoogle Scholar
  8. 8.
    Donabedian A (2003) An Introduction to quality assurance in health care. Oxford University Press, OxfordGoogle Scholar
  9. 9.
    Fahy M, Roche J, Weiner A (2005) Beyond governance. Creating corporate value through performance, conformance and responsibility. John Wiley & Sons Ltd, ChichesterGoogle Scholar
  10. 10.
    Gilardi F (2004) Institutional change in regulatory policies: Regulation through independent agencies and the three new institutionalisms. In Jordana J, Levi-Faur D (eds) The politics of regulation. Institutions and regulatory reforms for the age of governance. The crc series on competition, regulation and development. Edward Elgar Publishing Limited, CheltenhamGoogle Scholar
  11. 11.
    Guichard S (2004) The reform of the health care system in Portugal, economics department working papers No. 405, Organisation for Economic Co-operation and Development, OctoberGoogle Scholar
  12. 12.
    Kon J (2003) Understanding regulation and compliance. Securities Institute Services, LondonGoogle Scholar
  13. 13.
    Majone G (1994) The rise of the regulatory state in Europe. West Eur Politics 17(3):77–101Google Scholar
  14. 14.
    Majone G (1997) From the positive to the regulatory state. J Public Policy 17(2):139–167CrossRefGoogle Scholar
  15. 15.
    Mallin C (2004) Corporate governance. Oxford University Press, OxfordGoogle Scholar
  16. 16.
    McSherry R, Pearce P (2002) Clinical governance. A guide to implementation for healthcare professionals. Blackwell Science, LondonGoogle Scholar
  17. 17.
    Mullen P, Spurgeon P (2000) Priority setting and the public. Radcliffe Medical Press, AbingdonGoogle Scholar
  18. 18.
    NICE (2002) Principles for best practice in clinical audit, National Institute for Clinical Excellence. Radcliffe Medical Press, LondonGoogle Scholar
  19. 19.
    Saltman R, Figueras J (1997) European health care reform, analysis of current strategies, copenhagen: WHO regional publications. Eur Ser N 72Google Scholar
  20. 20.
    Saltman R, Busse R (2002) Balancing regulation and entrepreneurialism in Europe’s health sector: Theory and practice. In: Richard B Saltman, Reinhard Busse, Elias Mossialos (eds) European observatory on health care systems regulating entrepreneurial behaviour in European health care systems. Open University Press, BuckinghamGoogle Scholar
  21. 21.
    Selznick P (1985) Focusing organisational research on regulation. In: Noll R (ed) Regulatory policy and the social sciences. University of California Press, BerkeleyGoogle Scholar
  22. 22.
    Sussex J (2001) The economics of the private finance initiative in the NHS. Office of Health Economics, LondonGoogle Scholar
  23. 23.
    Walshe K (2002) The rise of regulation in the NHS. Br Med J 324:967–970CrossRefGoogle Scholar
  24. 24.
    Walshe K (2003) Regulating healthcare. A prescription for improvement? State of Health Series. Open University Press, MaidenheadGoogle Scholar
  25. 25.
    Whincop M (2001) Bridging the entrepreneurial financial gap. Linking governance with regulatory policy. Ashgate Publishing Limited, BurlingtonGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Rui Nunes
    • 1
    • 2
    • 3
  • Guilhermina Rego
    • 1
  • Cristina Brandão
    • 1
  1. 1.Faculty of Medicine of the University of PortoPortoPortugal, EU
  2. 2.Former President of the Regulatory Authority of HealthPortoPortugal, EU
  3. 3.Estrada da CircunvalaçãoPortoPortugal, EU

Personalised recommendations