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2 Regul. & Governance 1 (2008)

handle is hein.journals/rgulangnce2 and id is 1 raw text is: Regulation & Governance (2008) 2, 1-8 GUEST EDITORS' INTRODUCTION Health care and new governance: The quest for effective regulation We are witnessing major changes in the governance of health care around the world in response to dramatic developments in medicine and the global economy. Sweeping reforms have been introduced. New institutional forms are emerging. Regulation is evolving into a more complex institutional matrix that uses multiple tools. The result has been the emergence of new forms of governance that seem better adapted to current needs. Much more must be done, but a major transformation is underway. These changes echo an earlier period of health care reform, and show remarkable continuities with the pragmatist tradition that emerged initially in the US in the nineteenth century, and spread in various forms throughout the world. A hallmark of this tradition, from John Dewey on, is the search for knowledgeable and effective institutions responsive to changing social needs, aspirations, and visions of a just society. From this vantage point, write Nonet and Selznick, the paradigmatic function of law is responsive regulation, mean- ing (among other things) regulatory institutions committed to (i) enlarging their scope of inquiry to embrace knowledge of the social contexts and effects of regulatory decisions; (ii) a style of reasoning that reaches beyond mere rule-following by focusing on social con- sequences; and (iii) testing alternative strategies for the implementation of mandates and reconstructing those mandates in the light of what is learned (Nonet & Selznick 1978). In the early twentieth century, this pragmatic search for more knowledgeable and effective institutions in health care was inspired by a mid-nineteenth century insight of revolutionary proportions: the recognition that medical knowledge is not something fixed but something that grows and evolves (Ludmerer 1999, p. 65). Reformers of that day confronted a new model of medicine, new sources of information, and a revolt against formalism. Drawing on pragmatist insights, they created new regulatory frame- works to deal with the medical, moral, social, and economic aspects of the health care revolution of their time, thus transforming hospitals and medical schools. Today, the global society faces challenges of a different order - another revolution in medical knowledge and the emergence of new information technologies - but the pragmatist approach still guides the search. A reaction against top-down regulatory models, reminiscent of the earlier revolt against formalism, has opened the door to new governance approaches. These innovations build on 100 years of experience with regulation. This special health care issue of Regulation & Governance examines some of the regulatory institutions involved in this complex contemporary transformation, paying special attention to the problems they faced and methods developed to address these challenges. Setting the stage for the articles that follow, Part 1 of this introduction sketches some of the main problems facing health care regulation in the US and Europe, while Parts 2 to 5 consider the regulatory response in light of four key themes: pluralism, participation, accountability, and capacity. © 2008 The Authors Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd doi:10.1111/j.1748-5991.2007.00030.x

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