How is the public Interest protected? the policy-making and intelligence tasks, regulation has to encompass all health actions and actors, and not just those of the health ministry or the public sector. While the public health care system is often replete with regulations, few countries(with either high or low income) have developed adequate strategies to regulate the private financing and provi sion of health services. The rethinking of a consistent set of regulatory approaches to pri- vate providers and sources of finance, in line with national goals and priorities, is a to priority task in most countries. gulation can either promote or restrict. Since the private sector comprises many differ- ent players, national policy needs to distinguish carefully where to promote and where to restrict. A single position on the private sector is unlikely to be appropriate In promotive terms, explicit incentives may be provided for private practice such as the sale of public assets, preferential loans, or donations of land. Tax incentives may be offered to promote private provision, with no or very little government regulation of providers market behav iour. China re-legalized private practice in the 1980s and promoted joint public/private ventures in hospital ownership. Thailand,'s finance ministry offers tax incentives to private hospital investors At the other extreme, significant barriers to market entry have sometimes such as a legal ban on private practice. This is still the case in Cuba and was previously in Ethiopia, Greece(for hospitals), Mozambique, the United Republic of Tanzania and several other countries. Between these extremes are policies that allow relatively free market entry, provide modest incentives, or have limited prerequisites for those wishing to enter the private market, including some standards for market behaviour and some level of oversight Incentives for greater private sector opportunities in health are often sought by govern- ment agencies other than the health ministry, and by private investors themselves. Finance, rade, and development ministries often advocate greater private investment in health in line with overall economic liberalization strategies Promotive policies seem to work, contributing to growth in private finance and provi sion(12, 13). But they have also had serious side-effects: rising inequities, uneven quality of care, and inefficiency. The health ministry needs to know in advance what conditions it will require for such investments to contribute to the efficiency, quality, or equity goals of th health system, and how to defend the view that health is not just like all other sectors The harm caused by market abuses is difficult to remedy after the fact. The United States is probably the best-documented case of regulators trying to catch up with private health insurers(14). State governments have extensive laws, regulations and enforcement author ity over private insurers in the USa to ensure fair competition, assure quality and generally protect consumers from fraudulent marketing. This regulatory framework took many years to develop and is still far from perfect: it does not guarantee insurance for everyone. Recent ea access but not the affordability of, private by small employers and individuals. Private employers have devised various ways of avoid he rules, so as to come under the looser federal regulations. But the system prevents many of the worst abuses- financially unsound or unscrupulous insurers-and hell ameliorate many market failures. Chile and South Africa have similar experiences in regu lating private health insurance practice. South Africa has recently changed earlier regula- tions governing medical schemes to reduce risk selection and increase risk pooling(see Box Chile has been unable to establish explicit contractual obligations for private insurers or prohibit risk selection by these private companies, due to the political influence of insurersHow is the Public Interest Protected? 125 the policy-making and intelligence tasks, regulation has to encompass all health actions and actors, and not just those of the health ministry or the public sector. While the public health care system is often replete with regulations, few countries (with either high or low income) have developed adequate strategies to regulate the private financing and provi￾sion of health services. The rethinking of a consistent set of regulatory approaches to pri￾vate providers and sources of finance, in line with national goals and priorities, is a top priority task in most countries. Regulation can either promote or restrict. Since the private sector comprises many differ￾ent players, national policy needs to distinguish carefully where to promote and where to restrict. A single position on the private sector is unlikely to be appropriate. In promotive terms, explicit incentives may be provided for private practice such as the sale of public assets, preferential loans, or donations of land. Tax incentives may be offered to promote private provision, with no or very little government regulation of providers’ market behav￾iour. China re-legalized private practice in the 1980s and promoted joint public/private ventures in hospital ownership. Thailand’s finance ministry offers tax incentives to private hospital investors. At the other extreme, significant barriers to market entry have sometimes been created, such as a legal ban on private practice. This is still the case in Cuba and was previously in Ethiopia, Greece (for hospitals), Mozambique, the United Republic of Tanzania and several other countries. Between these extremes are policies that allow relatively free market entry, provide modest incentives, or have limited prerequisites for those wishing to enter the private market, including some standards for market behaviour and some level of oversight and enforcement. Incentives for greater private sector opportunities in health are often sought by govern￾ment agencies other than the health ministry, and by private investors themselves. Finance, trade, and development ministries often advocate greater private investment in health in line with overall economic liberalization strategies. Promotive policies seem to work, contributing to growth in private finance and provi￾sion (12, 13). But they have also had serious side-effects: rising inequities, uneven quality of care, and inefficiency. The health ministry needs to know in advance what conditions it will require for such investments to contribute to the efficiency, quality, or equity goals of the health system, and how to defend the view that health is not just like all other sectors. The harm caused by market abuses is difficult to remedy after the fact. The United States is probably the best-documented case of regulators trying to catch up with private health insurers (14). State governments have extensive laws, regulations and enforcement author￾ity over private insurers in the USA to ensure fair competition, assure quality and generally protect consumers from fraudulent marketing. This regulatory framework took many years to develop and is still far from perfect: it does not guarantee insurance for everyone. Recent regulatory changes have improved access to, but not the affordability of, private insurance by small employers and individuals. Private employers have devised various ways of avoid￾ing the rules, so as to come under the looser federal regulations. But the system prevents many of the worst abuses – financially unsound or unscrupulous insurers – and helps to ameliorate many market failures. Chile and South Africa have similar experiences in regu￾lating private health insurance practice. South Africa has recently changed earlier regula￾tions governing medical schemes to reduce risk selection and increase risk pooling (see Box 6.5). Chile has been unable to establish explicit contractual obligations for private insurers or prohibit risk selection by these private companies, due to the political influence of insurers