Health systems in many low- and middle-income countries (LMICs) in the Asia-Pacific region can be characterised as mixed public-private systems, with common features such as blurred boundaries between public and private sectors, low government investment in public services and ineffectual policies and institutions for regulating health care.
As a result, they encounter a range of performance issues, including poor quality and inequitable coverage of health services, health providers who exploit their market position for personal gain and high out-of-pocket expenditure for users, particularly the poor.
Such problems reflect failures in the regulation of health care providers. However, in LMICs there is often little information on the specific nature of these failures or their causes to guide national and sub-national authorities in strengthening the regulation of their health systems.
The Nossal Institute for Global Health and the Public Health Foundation of India collaborated in the development of a structured assessment tool that can be used to describe and assess regulatory systems and organisations and to identify gaps in the design, and failures in the implementation, of regulatory systems. The tool was then tested by assessing the regulatory systems at two sites in India with very different demographics and health care systems: Madhya Pradesh and Delhi.