Decentred regulation: The case of private healthcare in India.
Decentred regulation: The case of private healthcare in India.
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Decentred regulation：The case of private healthcare in India.
DOI：
10.1016/j.worlddev.2022.105889
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发表时间：
2022-07
影响因子：
6.9
通讯作者：
Chakravarthi I
中科院分区：
文献类型：
--
作者：
Hunter BM;Murray SF;Marathe S;Chakravarthi I
对社会部门监管的研究需要认识到更广泛的国家和非国家行为者。政府和法定委员会很重要，但认证公司、保险公司、平台运营商和消费者法院也很重要。基于个人和网络自由裁量权的非正式方法也会影响管理和实践。监管活动是为了追求行为者自身利益，对社会公平产生影响。采用分散的方法来研究监管可以揭示这些复杂的系统及其对社会福利的影响。为了实现更公平的社会福利制度，我们需要更好地了解卫生和教育等社会部门的监管。然而，迄今为止的研究往往侧重于政府和专业人士的作用，忽视了在基于市场的供应和部分国家监管的背景下出现的更广泛的监管体系。在本文中，我们使用“去中心化”和“监管资本主义”视角的分析方法来研究印度私人医疗保健的监管。我们将这些想法应用于马哈拉施特拉邦私人医疗保健及其监管的定性数据（新闻媒体审查、对 43 名受访者的半结构化访谈以及三场证人研讨会），以便描述在此背景下参与制定规则和规范的国家和非国家行为者的范围、这些活动代表了哪些利益以及出现了哪些问题。我们展示了一套正在运行的不拘一格的监管体系。政府和法定委员会确实发挥有限且零星的监管作用，通常围绕立法、许可和检查进行组织，并且通常由国家司法部门推动。但一系列行业层面的参与者、私人组织和公共保险公司也参与其中，通过监管资本主义的办公室：认证公司、保险公司、平台运营商和消费者法院，促进自己在该行业的利益。规则和规范广泛但分散。这些不仅是通过法律、许可和专业行为准则产生的，而且还通过行业对标准、实践和市场组织的影响，以及通过谈判例外和补救措施的个性化尝试而产生。我们的研究结果表明，市场化社会部门的监管是片面的、脱节的、分散到多个地点的，积极代表不同的利益。更好地了解在这种背景下发挥作用的不同行为者和进程可以为未来实现普遍社会福利制度的进展提供信息。
The study of regulation in social sectors needs to recognise a wider range of state and non-state actors. Governments and statutory councils are important, but so too are accreditation companies, insurers, platform operators and consumer courts. Informal approaches based on individual and networked discretion also influence management and practice. Regulatory activities are performed in pursuit of actors’ own interests, with implications for social equity. Adopting decentred approaches to studying regulation can shed light on these complex systems and their implications for social welfare. In order to progress towards more equitable social welfare systems we need an improved understanding of regulation in social sectors such as health and education. However, research to date has tended to focus on roles for governments and professions, overlooking the broader range of regulatory systems that emerge in contexts of market-based provisioning and partial state regulation. In this article we examine the regulation of private healthcare in India using an analytical approach informed by ‘decentred’ and ‘regulatory capitalism’ perspectives. We apply these ideas to qualitative data on private healthcare and its regulation in Maharashtra (review of press media, semi-structured interviews with 43 respondents, and three witness seminars), in order to describe the range of state and non-state actors involved in setting rules and norms in this context, whose interests are represented by these activities, and what problems arise. We show an eclectic set of regulatory systems in operation. Government and statutory councils do perform limited and sporadic regulatory roles, typically organised around legislation, licensing and inspections, and often prompted by the judicial arm of the state. But a range of industry-level actors, private organisations and public insurers are involved too, promoting their own interests in the sector via the offices of regulatory capitalism: accreditation companies, insurers, platform operators and consumer courts. Rules and norms are extensive but diffuse. These are produced not just through laws, licensing and professional codes of conduct, but also through industry influence over standards, practices and market organisation, and through individualised attempts to negotiate exceptions and redressal. Our findings demonstrate regulation in a marketised social sector to be partial, disjointed and decentred to multiple loci, actively representing differing interests. Greater understanding of the different actors and processes at play in such contexts can inform future progress towards universal systems for social welfare.
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影响因子：
6.1
作者：
Berkowitz, Heloise;Souchaud, Antoine
通讯作者：
Souchaud, Antoine
影响因子：
6.9
作者：
Braithwaite, John
通讯作者：
Braithwaite, John
影响因子：
3.2
作者：
Bhat, R
通讯作者：
Bhat, R
影响因子：
3.2
作者：
BHAT, R
通讯作者：
BHAT, R
影响因子：
10.8
作者：
Bloom G;Henson S;Peters DH
通讯作者：
Peters DH