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Inclusion by design? Rethinking health care market regulation in the Tanzanian context

Mackintosh, M   Tibandebage, P

Journal of Development Studies   39 (1) 1-20

January 2002   (Date deposited July 2006)

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.