Decentred regulation: The case of private healthcare in India

TY - JOUR

T1 - Decentred regulation

T2 - The case of private healthcare in India

AU - Hunter, Ben

AU - Murray, Susan F

AU - Marathe, Shweta

AU - Chakravarthi, Indira

N1 - Funding Information: The authors acknowledge the contributions to the conceptualisation and execution of the study from Abhay Shukla, Arun Gadre, Sanjay Nagral and Deepali S.Y. with particular thanks to Abhay Shukla for feedback on an early draft of the article. The authors also thank all the interviewees and participants at the witness seminars. The UK Joint Health Systems Research Initiative, funded by the UK Medical Research Council, Economic and Social Research Council, Department for International Development and Wellcome Trust, provided financial support through grant MR/R003009/1. According to UK research councils' Common Principles on Data Policy, and Wellcome Trust's Policy on data, software and materials management and sharing, all data supporting this study will be openly available via the UK Data Service athttps://www.ukdataservice.ac.uk/. Funding Information: The UK Joint Health Systems Research Initiative, funded by the UK Medical Research Council, Economic and Social Research Council, Department for International Development and Wellcome Trust, provided financial support through grant MR/R003009/1. Publisher Copyright: © 2022

PY - 2022/7/31

Y1 - 2022/7/31

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85126669564&partnerID=8YFLogxK

U2 - 10.1016/j.worlddev.2022.105889

DO - 10.1016/j.worlddev.2022.105889

M3 - Article

SN - 0305-750X

VL - 155

JO - WORLD DEVELOPMENT

JF - WORLD DEVELOPMENT

M1 - 105889

ER -