Transformative Education
for Health Professionals

Key Policy Issue #4: Who should regulate?

States with a tradition of centralization tend to assume this function through their ministries of health or education, or agencies created for that purpose. In others, the state has the ultimate responsibility for protecting public interest, but it delegates regulation rights and duties to professional councils. Regulation is done by peers instead of bureaucrats or the market (Girardi, 2008). However, increasingly in these situations, there is greater oversight and accountability of the regulator and a move to greater public engagement in regulation.

This is because it is increasingly recognized that the original impetus to statutory recognition was to secure a professional monopoly, the continued protection of which is not necessarily in the public interest. There are also independent organizations, such as professional associations, which in some countries may regulate access to medical specialties, or accreditation agencies which regulate educational institutions and programmes. In general, countries use a combination of these mechanisms. The effectiveness of each modality depends on numerous factors and varies according to the country, period and even the professional group (Friedson, 2001). The ability of the professions to govern themselves and to balance their self-interest with the public interest is an issue of continuing debate. To determine who should be the regulator and what should be its role, with what powers, and how and to whom it should be accountable is a matter of acceptability as much as of effectiveness. For example, in Australia and Canada, accreditation is a bottom-up peer-managed process whereas in France, it is government-led. In some instances, educational institutions apply the standards of international accreditation bodies, in addition to or in substitution of national mechanisms. This is the case for medical education in Canada, for public health in Europe, and for health services management in Canada and the United States of America, and increasingly in Asia, Europe and Latin America.