Public service markets: their economics, institutional oversight and regulation

Public services in the UK have been transformed over the past 25 years with the introduction of market oriented solutions into their provision. This has been characterised by a shift away from state provision to independent providers, and by the introduction of competition and choice. This shift was partly ideologically motivated and partly driven by budget cutting considerations following the financial crisis. As such it has been lacking a comprehensive economic justification or method of analysis. It is now commonly accepted that the language of economic markets is essential to frame arguments about how effectively public services are achieving their intended outcomes. Using market language and concepts may not always be comfortable for those from a traditional policy-making background. It can nevertheless be very useful when designing investigations into the effectiveness and value for money in the mechanisms of delivery of such services, whenever these services entail a degree of user choice as is currently the case in large parts of health, social care and education (referred to as competition in the market). Our paper wants to provide a conceptual basis on the way of thinking in these terms. We provide a description of the current state and then comment on the desirability of this quasi market approach. Uniquely in the literature, we analyse the expected and desired developments by distinguishing between choice and compulsory merit goods. In choice merit goods markets many users are unable to choose effectively because of the existence of a number of demand side or supply side market failures. Moreover, conflicts may exist between how service users actually make choices, and policy objectives such as universality or equity which may not be achieved simply by ‘leaving it to the market’. The users of compulsory merit goods are typically a minority and unable to internalise the full social benefits of their actions; hence it may be welfare-enhancing for society to coerce them ‘consume’ these services. As choice cannot be an objective, the commissioning (competition for the market) or direct provision by the state of such goods may meet public policy objectives more effectively than the market mechanism alone. Building on these foundations the paper discusses when public service markets are likely to be an effective method of achieving public policy objectives, and when they may not be. Our paper analyses the implications for the institutional and legal framework, funding oversight and regulation of public service markets as a result of their transformation into quasi-markets. The paper concludes with some suggestions for those charged with overseeing public service markets in practice based on this analysis

Redefining the State in Health Care Policy in Italy and the United States

\u9898\u76ee: \u91cd\u65b0\u5b9a\u4e49\u610f\u5927\u5229\u548c\u7f8e\u56fd\u7684\u533b\u7597\u653f\u7b56\u72b6\u51b5 \u5728\u610f\u5927\u5229\u548c\u7f8e\u56fd\u8fd9\u7c7b\u9ad8\u5ea6\u53bb\u4e2d\u5fc3\u5316\u653f\u6cbb\u4f53\u7cfb\u4e2d, 2008\u5e74\u5168\u7403\u91d1\u878d\u5371\u673a\u6700\u7ec8\u8ba9\u6b65\u4e8e\u4e2d\u592e\u653f\u5e9c\u5728\u653f \u7b56\u9886\u57df(\u5305\u62ec\u533b\u7597\u536b\u751f) \u6240\u53d1\u6325\u7684\u66f4\u4e3a\u5f3a\u5065\u7684\u5f71\u54cd\u529b\u3002\u5728\u610f\u5927\u5229\u56fd\u6c11\u536b\u751f\u670d\u52a1(Italian National Health Service) \u4e2d, \u4e2d\u592e\u653f\u5e9c\u52a0\u5f3a\u4e86\u6210\u672c\u63a7\u5236, \u5bf9\u653f\u7b56\u5236\u5b9a\u8fdb\u884c\u90e8\u5206\u518d\u4e2d\u5fc3\u5316, \u540c\u65f6\u7528\u9ad8\u989d\u8d64\u5b57\u9650 \u5236\u81ea\u6cbb\u533a\u57df\u3002\u5728\u7f8e\u56fd\u5360\u4e3b\u5bfc\u5730\u4f4d\u7684\u79c1\u4eba\u533b\u7597\u4f53\u7cfb\u4e2d, \u91d1\u878d\u5371\u673a\u4fc3\u4f7f\u7f8e\u56fd\u4e8e2010 \u5e74\u5b9e\u884c\u5e9e\u5927\u7684 \u8054\u90a6\u533b\u7597\u6539\u9769\u3002\u672c\u6587\u63d0\u51fa\u7591\u95ee: \u91d1\u878d\u5371\u673a\u548c\u56f4\u7ed5\u533b\u7597\u4f53\u7cfb\u7684\u6a21\u62df\u653f\u5e9c\u95f4\u80cc\u666f, \u8fd9\u4e8c\u8005\u5728\u8be0\u91ca\u201c\u4e24 \u79cd\u9ad8\u5ea6\u4e0d\u540c\u7684\u533b\u7597\u4f53\u7cfb\u7c7b\u578b\u4e4b\u95f4\u6240\u53d1\u73b0\u7684(\u518d) \u4e2d\u5fc3\u5316\u201d\u4e00\u4e8b\u65f6\u626e\u6f14\u4e86\u4f55\u79cd\u89d2\u8272? \u7b14\u8005\u5c24\u5176\u4f7f\u7528 \u76d1\u7ba1\u6742\u4ea4(regulatory hybridization) (Rothgang et al., 2010) \u8fd9\u4e00\u6982\u5ff5, \u548c\u7531\u65bd\u5bc6\u5fb7\u7b49\u4eba(2010) \u4ee5\u53caFrisina Doetter\u7b49\u4eba(2015) \u63d0\u51fa\u7684\u533b\u7597\u4f53\u7cfb\u53d8\u5316\u89e3\u91ca\u6a21\u578b\u6765\u68c0\u9a8c\u76f8\u5173\u8bc1\u636e\u3002\u4e3a\u6b64, \u7b14\u8005\u63a2 \u7d22\u4e86\u6839\u690d\u4e8e\u6b64\u6a21\u578b\u4e2d\u7684\u529f\u80fd\u4e3b\u4e49\u548c\u60c5\u5883\u56e0\u7d20\u4e4b\u95f4\u7684\u5173\u7cfb\u3002\u7814\u7a76\u7ed3\u679c\u5f3a\u8c03\u4e86\u4fee\u8ba2\u76d1\u7ba1\u6742\u4ea4\u6982\u5ff5\u7684 \u5fc5\u8981\u6027, \u4ece\u800c\u5141\u8bb8\u5c06\u66f4\u591a\u7684\u5206\u6790\u805a\u7126\u4e8e\u9886\u571f\u6743\u529b\u8f6c\u53d8, \u4ee5\u7406\u89e3\u53bb\u4e2d\u5fc3\u5316\u533b\u7597\u4f53\u7cfb\u4e2d\u7684\u53d1\u5c55\u3002In highly decentralized political systems such as in Italy and the United States of America (US), the global financial crises beginning in 2008 gave way to a more assertive role of the central government in policy areas including health. In the Italian National Health Service, the central government intensified cost containment, partially recentralizing policy-making and limiting the autonomy of Regions with high deficits. In the predominantly private health system of the US, crisis ushered in dramatic federal health reform in 2010. This study asks, what role did financial crisis and an analogous intergovernmental context surrounding health care play in explaining the (re)centralization observed between two highly divergent health system types? We examine evidence particularly with a view to the concept of regulatory hybridization (Rothgang et al., 2010) and the larger explanatory model of health care system change put forth by Schmid, Cacace, Gotze and Rothgang (2010) and Frisina Doetter, Gotze, Schmid, Cacace and Rothgang (2015). In doing so, we explore the relationship between functionalist vs. contextual variables embedded within the model. Our findings highlight the necessity to revise the concept of regulatory hybridization to allow for greater analytical focus on territorial shifts in power to understand developments in decentralized health care systems.Redefinir el estado en la pol\u131tica de atencion de salud en Italia y los Estados Unidos En sistemas pol\u131ticos altamente descentralizados, como en Italia y los Estados Unidos de America (EE. UU.), Las crisis financieras mundiales que comenzaron en 2008 dieron paso a un papel mas asertivo del gobierno central en areas pol\u131ticas, incluida la salud. En el Servicio Nacional de Salud de Italia, el gobierno central intensifico la contencion de costos, recentralizando parcialmente la formulacion de pol\u131ticas y limitando la autonom\u131a de las regiones con altos deficits. En el sistema de salud predominantemente privado de EE. UU., La crisis marco el comienzo de una dramatica reforma federal de salud en 2010. El presente estudio pregunta que papel tuvieron la crisis financiera y un contexto intergubernamental analogo relacionado con la atencion medica para explicar la (re) centralizacion observada entre dos altamente divergentes tipos de sistemas de salud. Examinamos la evidencia particularmente con una vista al concepto de hibridacion regulatoria (Rothgang et al., 2010) y el modelo explicativo mas amplio del cambio en el sistema de salud propuesto por Schmid et al. (2010) y Frisina Doetter et al. (2015). Al hacerlo, exploramos la relacion entre las variables funcionalistas frente a las contextuales integradas en el modelo. Nuestros hallazgos destacan la necesidad de revisar el concepto de hibridacion regulatoria para permitir un mayor enfoque anal\u131tico en los cambios territoriales en el poder y as\u131 comprender los desarrollos en los sistemas de salud descentralizados

Summarizing evidence on the personalisation of care in Europe

International audienc