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Inclusion by Design? Rethinking Health Care Market Regulation in the Tanzanian Context

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  • M. Mackintosh
  • P. Tibandebage

Abstract

In Tanzania, as in many other low income countries, health care is largely obtained through out-of pocket payment. The current liberalised health care market displays a pattern of exclusion, impoverishment, abuse and poor quality care alongside substantial patches of accessibility and probity, while the government has few resources for inspection and control. This article summarises new evidence on these points. It argues that it is nevertheless possible in these circumstances to pursue the stated aims of health care reform to improve inclusiveness and quality of care, but that to do so requires a rethinking of the dominant concept of health care market regulation as rule setting, moving instead towards a concept of collaborative regulatory intervention. Drawing on current thinking in economics, institutional theory and the theory of regulation, this article proposes such a regulatory framework of thought, which we label 'inclusion by design', and illustrates it with proposals developed within the Tanzanian context.

Suggested Citation

  • M. Mackintosh & P. Tibandebage, 2002. "Inclusion by Design? Rethinking Health Care Market Regulation in the Tanzanian Context," Journal of Development Studies, Taylor & Francis Journals, vol. 39(1), pages 1-20.
    • Handle: RePEc:taf:jdevst:v:39:y:2002:i:1:p:1-20
    DOI: 10.1080/713601263
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    Citations

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    Cited by:

    1. Maureen Mackintosh, 2006. "Commercialisation, inequality and the limits to transition in health care: a Polanyian framework for policy analysis," Journal of International Development, John Wiley & Sons, Ltd., vol. 18(3), pages 393-406.
    2. Peters, David H. & Muraleedharan, V.R., 2008. "Regulating India's health services: To what end? What future?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2133-2144, May.
    3. Dussault, Gilles, 2008. "The health professions and the performance of future health systems in low-income countries: Support or obstacle?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2088-2095, May.
    4. Ensor, Tim & Weinzierl, Sabine, 2007. "Regulating health care in low- and middle-income countries: Broadening the policy response in resource constrained environments," Social Science & Medicine, Elsevier, vol. 65(2), pages 355-366, July.
    5. Leach, Melissa A. & Fairhead, James R. & Millimouno, Dominique & Diallo, Alpha Ahmadou, 2008. "New therapeutic landscapes in Africa: Parental categories and practices in seeking infant health in the Republic of Guinea," Social Science & Medicine, Elsevier, vol. 66(10), pages 2157-2167, May.
    6. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    7. Lucas, Henry, 2008. "Information and communications technology for future health systems in developing countries," Social Science & Medicine, Elsevier, vol. 66(10), pages 2122-2132, May.
    8. Wafula, Francis & Molyneux, Catherine & Mackintosh, Maureen & Goodman, Catherine, 2013. "Protecting the public or setting the bar too high? Understanding the causes and consequences of regulatory actions of front-line regulators and specialized drug shop operators in Kenya," Social Science & Medicine, Elsevier, vol. 97(C), pages 220-227.
    9. Kruk, Margaret E. & Freedman, Lynn P. & Anglin, Grace A. & Waldman, Ronald J., 2010. "Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: A theoretical framework and research agenda," Social Science & Medicine, Elsevier, vol. 70(1), pages 89-97, January.

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