Can we rely on the altruism of professionals or the public service ethos to deliver good quality health and education services? And how should patients, parents, and pupils behave - as grateful ...recipients or active consumers? This book provides new answers to these questions - a milestone in the analysis and development of public policy, from one of the leading thinkers in the field. It provides a new perspective on policy design, emphasising the importance of analysing the motivation of professionals and others who work within the public sector, and both their and public service beneficiaries' capacity for agency or independent action. It argues that the conventional assumption that public sector professionals are public-spirited altruists or 'knights' is misplaced; but so is the alternative that they are all, in David Hume's terminology, 'knaves' or self-interested egoists. We also must not assume that individual citizens are passive recipients of public services (pawns); but nor can they be untrammelled sovereigns with unrestricted choices over services and resources (queens). Instead, policies must be designed so as to give the proper balance of motivation and agency. The book illustrates how this can be done by detailed empirical examination of recent policies in health services, education, social security and taxation. It puts forwards proposals for policy reform, several of which either originated with the author or with which he has been closely associated: universal capital or 'demogrants', discriminating vouchers, matching grants for pensions and for long-term care, and hypothecated taxes. Available in OSO: http://www.oxfordscholarship.com/oso/public/content/economicsfinance/0199266999/toc.html
The other invisible hand Le Grand, Julian
2008, 2007., 20090110, 2009, 2007, 2007-01-01, 20070101
eBook, Book
How can we ensure high-quality public services such as health care and education? Governments spend huge amounts of public money on public services such as health, education, and social care, and yet ...the services that are actually delivered are often low quality, inefficiently run, unresponsive to their users, and inequitable in their distribution. In this book, Julian Le Grand argues that the best solution is to offer choice to users and to encourage competition among providers. Le Grand has just completed a period as policy advisor working within the British government at the highest levels, and from this he has gained evidence to support his earlier theoretical work and has experienced the political reality of putting public policy theory into practice. He examines four ways of delivering public services: trust; targets and performance management; "voice"; and choice and competition. He argues that, although all of these have their merits, in most situations policies that rely on extending choice and competition among providers have the most potential for delivering high-quality, efficient, responsive, and equitable services. But it is important that the relevant policies be appropriately designed, and this book provides a detailed discussion of the principal features that these policies should have in the context of health care and education. It concludes with a discussion of the politics of choice.
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There are several models for delivering public services such as health care or education, most of which can be summarised under the headings of trust, mistrust, voice, and choice. Each contains ...assumptions concerning the motivation of the professionals and others who provide the service concerned: that is, the extent to which they are "knaves," motivated primarily by self-interest, or "knights," motivated by altruism and the desire to provide a public service. This article highlights the assumptions concerning motivation implicit in each of the delivery models, illustrating the points made by reference to the author's experience as a senior policy adviser to British Prime Minister Tony Blair and to some evidence on the performance of public services under the different models.
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The extent of altruistic behaviour and its relationship to the market has been a major interest of social policy analysts since the pioneering work of Richard Titmuss. Here we report on empirical ...research into such behaviour in consumer markets where self‐interest might be expected to dominate but whose participants are increasingly demonstrating more ethical concerns. We discuss three factors that have been hypothesized to affect the extent and depth of altruistic behaviour by individuals in such markets: the degree of personal sacrifice involved in the purchase, the reputation of individuals with their family and friends and individuals' sense of self‐identity. Using an online survey method, we measure consumers' motivations for real purchases in two different ethical consumerism settings: (RED) and Fairtrade. We find evidence to support all three hypotheses and conclude with some of the implications for social policy.
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This study aimed to evaluate whether subjective assessments of unmet need may complement conventional methods of measuring socioeconomic inequity in health care utilization. This study draws on the ...2003 Canadian Community Health Survey to develop a conceptual framework for understanding how unmet need arises, to empirically assess the association between utilization and the different types of unmet need (due to waiting times, barriers and personal reasons), and to investigate the effect of adjusting for unmet need on estimates of income-related inequity. The study's findings suggest that a disaggregated approach to analyzing unmet need is required, since the three different subgroups of unmet need that we identify in Canada have different associations with utilization, along with different equity implications. People who report unmet need due to waiting times use more health services than would be expected based on their observable characteristics. However, there is no consistent pattern of utilization among people who report unmet need due to access barriers, or for reasons related to personal choice. Estimates of inequity remain unchanged when we incorporate information on unmet need in the analysis. Subjective assessments of unmet need, namely those that relate to barriers to access, provide additional policy-relevant information that can be used to complement conventional methods of measuring inequity, to better understand inequity, and to guide policy action.
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Public service mutuals are a form of employee-led organization in which service workers spin out of the public sector to form "mutuals" that contract back with government to provide a service. This ...article draws on economic and psychological theory to demonstrate that mutuals can align both self-interested and altruistic or public service motivations so as to serve the social good; moreover, by offering greater autonomy to public service professionals, mutuals are predicted to encourage energetic and persistent behaviors. In both cases, there is an advantage over alternative forms of organization such as the public sector bureaucracy, the shareholder-owned private firm, or the nonprofit organization. The employee-led mutual form, however, may not appeal to risk-averse workers, its collective decision-making systems may be inefficient, and external mechanisms may be required to ensure that organizational outcomes are always directed toward the social good.
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Should governments save people from themselves? Do governments have the right to influence citizens' behaviour related to smoking tobacco, eating too much, not saving enough, drinking alcohol, or ...taking marijuana - or does this create a nanny state, leading to infantilization, demotivation, and breaches in individual autonomy? Looking at examples from both sides of the Atlantic and around the world, 'Government Paternalism' examines the justifications for, and the prevalence of, government involvement and considers when intervention might or might not be acceptable.
Sir William Beveridge in his famous report wanted to eliminate the five giants of want, squalor, idleness, ignorance and disease: the giants of too little. However, the problems facing welfare states ...are more the giants of too much: the giants of excess. For health in particular, excessive behaviours of various kinds contribute significantly to the major sources of morbidity and mortality in our society, including cancer, heart disease, stroke, diabetes and kidney and liver diseases. There are few good theories about why individuals engage in excess behaviours. But it is clear that one of the main problems that face both individuals and the government or other agencies tasked with improving health is that the costs of most unhealthy activities impact in the future, whereas the benefits from them occur in the present. Policies have to be developed that either bring some of the costs from unhealthy activities (or the benefits from healthy ones) back from the future, or reduce some of the benefits from unhealthy activities (or reduce the costs of healthy ones) in the present. To avoid the danger of the 'nanny state', they should also not impact too greatly on individual freedom or autonomy. Promising ideas that meet these criteria, which are derived from the philosophy of libertarian paternalism, include smoking permits and exercise hours.
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9.
Social Exclusion in Britain 1991-1995 Burchardt, Tania; Le Grand, Julian; Piachaud, David
Social policy & administration,
September 1999, Volume:
33, Issue:
3
Journal Article
Peer reviewed
The purpose of this paper is to offer a working definition of social exclusion and to operationalize it in such a way that an initial empirical analysis of social exclusion in Britain today can be ...undertaken. After a brief review of conceptions of social exclusion and some of the key controversies, we operationalize one definition based on the notion of participation in five types of activity—consumption, savings, production, political and social. Using the British Household Panel Survey, indicators for participation on these dimensions are developed and analysed both cross‐sectionally and longitudinally for the period 1991–5. We find strong associations between an individual’s participation (or lack of it) on the five different dimensions, and on each dimension over time. However, there is no distinct group of socially excluded individuals: few are excluded on all dimensions in any one year and even fewer experience multiple exclusion for the whole period. The results support the view that treating different dimensions of exclusion separately is preferable to thinking about social exclusion in terms of one homogeneous group.
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There are four basic models of health service delivery: those that rely on trust, on command and control, on voice, and on choice and competition. All have their merits and demerits; but there are ...both theoretical and empirical arguments for preferring choice and competition in many situations. However, the relevant policies do have to be properly designed.
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