TRUST and the Regulation of the Medical Profession in the Health System in India

The general intention of systems of regulation is to control the practices of actors to achieve a variety of economic and social objectives in the public interest. This paper examines the current regulatory regimes and practices in the health system in India using the trust/control duality as an analytical frame. In doing so it critically reflects upon the stewardship and governance of the health system, exposing the limits and fragilities of the current regulatory approach to controlling health system actor’s behaviours and practices. It draws on evidence from an exploratory study of trust relations carried out by the authors in one region of India. Evidence and insight from this analysis are used to depict the nature of trust relations and regulation in the health system, and the problems therein, and to explain why they take that shape. The final part of the paper outlines possible strategies for effective stewardship and governance of health systems, and concludes with identifying gaps in the research evidence.