Balancing Tensions in Regulatory Reform: Changes to Regulation of Health Professions in Australia, the United Kingdom, and Ontario, Canada

Regulation of health professions is a dynamic field that continues to cause strife among policy, government, and regulatory actors. At the heart of these debates is the question of how to balance the potentially conflicting policy tensions in the regulatory agenda: professional versus public interests, transparency versus privacy, and accountability versus autonomy. In recent years, the balance of these tensions has shifted in many jurisdictions through legislative reform, impacting the relationship between governments and health profession regulators. This changing balance and the factors and forces behind it were examined using a qualitative multiple case study research design of Australia, the United Kingdom, and Ontario, Canada. In Australia, the struggle between striving for national uniformity while still achieving adequate accountability was dominant after the enactment of a nationally coordinated regulatory scheme and subsequent state-based deviations. In the United Kingdom, the balance between autonomy for regulators and legislated consistency was contentious following the creation of a powerful meta-regulator and the elimination of elected professional majorities on regulatory bodies. Reform in Ontario was more incremental, with continued adherence to elements of traditional self-regulation, including professional majorities on governing councils of regulators and considerable delegated power for these professional regulators. Despite this, the nature of health profession self-regulation in Ontario has been altered through enhanced government oversight powers, heightened accountability and transparency requirements, and constrained discretion for regulatory bodies. The level of autonomy and freedom from state intrusion that self-regulated health professions previously enjoyed are unlikely to be seen in Ontario again. It is clear there is no panacea for perceived problems in regulation of the health professions. Reform agendas were coloured by the modern political, legal, and social context of each jurisdiction. These findings help elucidate the different policy tensions that have informed the reform. Certain values are gaining greater traction in each regulatory framework, including the importance of transparency and collaboration, the need to balance regulatory force to ensure economic viability, the utility of articulating regulatory principles, and the necessity of sustaining governmental and societal confidence in the ability to do what regulation of health professions is supposed to: protect the public.Ph.D.2018-11-03 00:00:0