Regulation is a critical component of healthcare and healthcare insurance. The role of regulatory bodies is to protect healthcare consumers from health risks, to provide a safe working environment for healthcare professionals, and to ensure that health programs serve public health and welfare. Regulation operates on all levels, and regulatory standards are developed by government and private organizations.
Regulations are required to standardize and supervise healthcare, ensuring that healthcare bodies and facilities comply with public health policies and that all patients and visitors to the healthcare system receive safe care.
As a result, regulatory agencies monitor individual and corporate healthcare practitioners and facilities; inform the government about changes in how the healthcare industry operates; ensure higher safety standards; and strive to improve healthcare quality while adhering to local, state, and federal guidelines.
A regulator’s functions
A regulatory system monitors how well the healthcare system meets its contractual obligations and other legal requirements, thereby protecting the public interest. Aside from the contracts themselves, it also specifies the standards for technical operations, safety, and quality and the penalties for noncompliance.
The regulation includes cost-effectiveness analyses, performance evaluations, tariff evaluations, and regular reviews, as well as the establishment of mechanisms for resolving disputes between parties. The regulatory body also advises the government on public-private partnerships in healthcare, assisting in developing policies and other related matters.
Non-statutory vs. statutory bodies
As a result, statutory bodies publish quality standards, provide accreditation, and provide continuing education and training to healthcare professionals. This type of regulatory body may regulate services or professionals.
In contrast to governmental oversight, accreditation agencies provide a voluntary level of management that includes quality certification and rankings, incentivizing efforts to improve healthcare quality and promoting best practices. These take a more indirect approach but aim to improve patient care.
The advantages and disadvantages
Regulatory activities aim to develop appropriate motivations, attitudes, policies, and healthcare protocols within facilities and systems. Regular inspections and measures to improve good practice and clinical culture are examples of regulatory activities.
On the other hand, slavish imposition of regulations may fail to address real problems of attitude and a non-professional approach to healthcare, is not flexible enough to deal with challenges and changes in the industry and may promote a bureaucratic pattern of mechanically complying with rules rather than seeking the welfare of the patient.
Some may perceive it as interference from an outside authority that reduces work efficiency and interferes with the smooth operation of the clinical service. Still, regulatory oversight is intended to cover a broader range of functions. Many individual and corporate observers have advocated for regulatory reform, resulting in a simplified approach that groups together regulations relating to similar services and reduces the burden on healthcare providers.
The main issues are:
- Multiple regulatory bodies with similar goals.
- A complex and rapidly changing regulatory environment.
- Duplication of work increases workload and creates frustration and antagonistic relationships with regulatory bodies.
Identify at least two regulatory bodies, and your state’s nurse practice act, that specify certification, licensure requirements, or scope of practice for your specialty. Discuss the way these influence the educational requirements and experiences for your specialty. Advanced practice registered nurses must incorporate the APRN consensus model in their response.
In your response to peers, discuss a specific guideline or change imposed by a regulating body or industry regulation and explain the how this affects your daily practice. Cite at least one source to support your response.