Regulating India's health services: To what end? What future?
Regulating India's health services: To what end? What future?
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DOI：
10.1016/j.socscimed.2008.01.037
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发表时间：
2008-05-01
影响因子：
5.4
通讯作者：
Muraleedharan, V. R.
中科院分区：
文献类型：
--
作者：
Peters, David H.;Muraleedharan, V. R.
印度拥有全面的法律和监管框架和庞大的公共卫生提供系统，这与大多数印度人的保健提供和筹资的现实脱节。在审查当前的官僚监管方法时，我们发现了一套广泛的规则和程序，尽管我们认为它在三个关键方面失败了，即：(1)保护弱势群体的利益；(2)展示医疗融资如何满足公共利益；(3)赢得提供者和公众的信任。该文件回顾了印度使用消费者和基于市场的方法以及多行为者和协作方法对卫生服务进行监管的替代方法的状况。我们认为，监管不善是治理不善的一个症状，仅仅创建和执行这些规则将继续产生有限的影响。我们不是主张更好地实施和扩大目前的官僚方法，而是主张印度未来的卫生系统更有可能通过更多地关注消费者和其他以市场为导向的方法，以及通过加强问责的合作机制来实现其目标，而不是倡导更好地实施和扩大卫生部作为检查者和提供者的角色。民间社会组织、媒体和提供者组织可以在披露和使用有关卫生资源使用情况和公共和私营提供者业绩的信息方面发挥更积极的作用。如果印度卫生部积极促进这些关键利益攸关方的参与和信息的使用，对卫生部门的概述将更加有效。(C)2008爱思唯尔有限公司。保留所有权利。
India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India's future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information. (C) 2008 Elsevier Ltd. All rights reserved.