Do they work? Regulating for-profit providers in Zimbabwe
Do they work? Regulating for-profit providers in Zimbabwe
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DOI：
10.1093/heapol/15.4.368
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发表时间：
2000-12-01
影响因子：
3.2
通讯作者：
Kumaranayake, L
中科院分区：
文献类型：
--
作者：
Hongoro, C;Kumaranayake, L
低收入和中等收入国家在卫生部门的规章和立法方面的经验与加拿大和欧洲形成鲜明对比。这表明，监管机制对澜湄合作私营部门活动的影响程度相当低。然而，很少有人研究这些法规是如何失败的，以及在多大程度上失败了。通过使用利益攸关方访谈，本研究探讨了针对津巴布韦私营-营利部门（全科医生、私人诊所和医院）的法规的有效性。研究发现，政府机构和私人供应商对基本法规的了解有限且不对称。然而，有一种明显的感觉，即法规没有得到有效的实施和执行。在私营提供者中观察到各种机会主义做法，包括：自我转诊的做法，将患者送到提供者有经济利益的其他服务；服务;医患串通骗取医疗保险费用；以及在私人场所使用无证员工。限制卫生部门监管效力的关键因素包括监管机构过于集中和缺乏独立性，缺乏控制医疗价格的法律机制，以及患者不了解自己的权利。该研究还确定了一些改善当前监管环境的潜在战略。在考试方面，为了加强监督，中央监管机构和地方当局之间形成了“非正式”安排。有必要设法使这些当局的作用正规化。此外，还将私营供应商的专业协会确定为关键参与者，通过这些协会，可以改善监管对私营供应商的影响。增加消费者获取信息和知识的机会是在监管过程和执行中改进信息的另一种潜在方法。
The experience of low- and middle-income countries (LMC) with respect to regulation and legislation in the health sector is in marked contrast to that of Canada and Europe. It is suggested that the degree to which regulatory mechanisms can influence private sector activity in LMC is quite low. However, there has been little work done on exploring just how, and to what extent, these regulations fail. Through the use of stakeholder interviews, this study explored the effectiveness of regulations directed at the private-for-profit sector (general practitioners, private clinics and hospitals) in Zimbabwe. The study found that there was limited and asymmetric knowledge of basic regulations among government bodies and private providers.However, there was a clear feeling that regulations are not being implemented and enforced effectively. A variety of opportunistic practices have been observed among private providers, including: practices of self-referral, where patients are sent to other services the provider has a financial interest in; over-servicing; doctor-patient collusion to collect health insurance payments; and the use of unlicensed staff in private facilities. Key factors limiting effectiveness of regulation in the health sector include the over-centralization and lack of independence of the regulatory body, the absence of legal mechanisms to control the price of care, and the lack of knowledge by patients of their rights. The study also identified a number of potential strategies for improving the current regulatory environment. For exam pie, in order to improve monitoring, 'informal' arrangements between the centralized regulatory body and local authorities developed. There is a need to develop ways to formalize the role of these authorities. In addition, professional associations of private providers are also identified as key players through which to improve the impact of regulation among private providers. Increasing consumer access to information and knowledge is another potential way to improve information within the regulatory process as well as implementation.