Page 163 - Human Rights

Faculty of Nursing
Adult care Nursing Department

In vertical healthcare systems in which financing and provision are accomplished in a hierarchical

manner, regulation is always integrated with the delivery of healthcare.

Direct regulation is a fundamental component of integrated vertical systems (Baldwin et al. 2011).

If competition is accepted as necessary for the healthcare industry, independent regulation is

potentially more effective than direct government regulation if the government itself is a player

in healthcare delivery.

It will be easier for direct regulators to be captured by the government through political influence
and indirectly by financial constraints on regulatory activity.

Financial autonomy, accrued primarily from fees raised by regulated organizations, is a distinctive

feature of independent regulators; this is why direct regulators cannot truly behave like

independent ones.

In a traditional vertical system, the accountability of elected public officials can improve
transparency and the social justice aspects of regulatory functions; however, when public hospitals

compete with private ones for a government contract, independent regulation is the most

effective way to guarantee that decisions are not politically undermined.

When the regulator must make complex and difficult choices regarding prioritizing services to be
delivered to the public, independent regulators are better suited to accomplish fair decision-

making.

In summary, the institutional nature of the regulator is a determinant in the regulatory outcome.

There are similarities between direct and independent regulation, namely the existence of a legal

framework that guides regulatory activity, centralized activity over the healthcare system, and the

pursuit of the public good, including ensuring equitable access to and quality of healthcare

(Donabedian 2003).

141 Academic Year 2025/2026