The role of regulation in healthcare

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e821 (Published 10 February 2012) Cite this as: BMJ 2012;344:e821
  1. Richard B Saltman, professor of health policy and management
  1. 1Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
  1. rsaltma{at}emory.edu

Needs further scrutiny before regulatory bodies can perform effectively

In November 2011, the healthcare think tank, the King’s Fund, published an assessment of the responsibilities and prospects for the newly redesigned Monitor, the independent regulator of NHS foundation trusts.1 The report explores several sensitive problems that inevitably face a newly beefed up health sector regulator.

Regulation has become an increasingly important part of the political toolbox in European healthcare systems that are funded by taxation. When healthcare providers were directly ruled by a central or regional government office, their decision making discretion was typically limited to informal strategies to create small degrees of autonomy within government directives.2 3 Regulation was rule based, serving mostly to convey higher level political decisions to lower operating levels of the delivery system.

With the onset of planned markets in the early 1990s, the role of regulation changed. In a …

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