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  • Author or Editor: Julian Le Grand x
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This chapter examines quasi-markets in publicly funded systems of healthcare, particularly as they have developed in the UK in the last two decades. It begins with a brief review of the theory behind the use of quasi-markets as a mechanism for delivering healthcare. It then considers some of the empirical evidence concerning quasi-markets in practice, concentrating on the impact of patient choice and competition — the principal elements of the new quasi-market — in healthcare systems that have already tried them, including the UK Conservative government’s internal market. Finally, it draws on that experience to discuss some of the conditions necessary for the quasi-market to deliver high-quality, efficient and equitable healthcare — that is, for the healthcare system to work.

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In thinking about social justice, it is important not to use ideas that violate people’s intuitions as to what is fair or just. It is both foolish and impolitic to try to impose some top-down principle of justice that would lead to situations being described as fair that most people think are manifestly unfair, or consider situations to be unjust that most would consider just. What is needed is a conception of justice that is firmly rooted in people’s intuitions; one that is general enough to command consensus, but specific enough to yield useful policy prescriptions.

One such conception relates social justice to the extent that individuals have control over their own lives. It states that, if one individual is deprived relative to another due to social factors beyond their control, then that situation is unjust.

The roots of this conception derive from the fact that our attitude towards the justice of individuals’ position in life is affected by any knowledge we may have of how they got into that position. We cannot simply observe two people with different incomes and then decide that this situation is unjust; we need to know the factors that have contributed to their poverty or wealth, and whether they have control over those factors. For instance, suppose we discover that the two had equal ability, but one of them lived in a deprived area with poor schools while the other grew up in a wealthy district with good local schools. The individual from the wealthier area got the A-level grades to go to university and went on to a professional career, while the equally-able individual from the poor area, because of inadequate schooling, had to take an unskilled job on a low wage.

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Newton and Sharpe in their contribution to this volume have drawn attention to the urgent need for developing a general theoretical framework in which future output research (in the area of British local government) can be undertaken. It is our intention in this paper to explore the possibility of rectifying this omission by the application of some theoretical constructs used by economists in the study of economic behaviour. More specifically, we examine a simple model of government behaviour incorporating the concepts of a social welfare function and production function, illustrate how it might be used in the British case to provide some insight into the determinants of local authority output decisions, and examine some of the difficulties involved. We do not present any empirical tests, and our conclusions must therefore be qualitative and highly tentative. Nonetheless it seems worth while to discuss the approach in the hope that it may be useful for subsequent empirical work.

In the first section, we examine some of the weaknesses in previous studies of UK local government expenditure.

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This paper is a study of fiscal incidence, but a rather unusual one. Instead of attempting to determine the impact of the welfare state on a representative sample survey, it attempts to assess that impact on two hypothetical families over their life-times: the working class Ackroyds and the middle class Osbornes. It examines the amounts the families receive in cash benefits, the costs of the social services they use and the value of the taxes they pay to finance those benefits. It concludes that, while cash benefits except old age pensions benefit the Ackroyds more than the Osbornes, pensions and social services overwhelmingly favour the Osbornes. However, when finance is taken into account, the system as a whole may redistribute income.

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This article reviews the social care evidence concerning direct payments/personal budgets, before arguing for an extension of these concepts to the National Health Service (NHS). Despite a commitment to inter-agency health and social care, direct payments/personal budgets have only been available for the ‘social care’ part of people's lives. Moreover, many of the challenges faced by the NHS are precisely those which social care has turned to more individualised funding to help resolve. Against this background, the article speculates as to how such a system might work and seeks to address some popular misconceptions and potential objections.

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The poll tax reform of local government finance in Britain is justified in part by arguments for using a ‘benefit tax’, which relates tax to the use made of local services. We review the theory of local public finance and find some support for this argument, although this is not overwhelming and neither the Government nor the theoretical literature provide any empirical evidence on the actual pattern of service benefits. This article attempts to rectify this omission by drawing on unique new household survey evidence from the County of Cheshire, which enables the cost of services used by each of a representative sample of households to be estimated. The distribution of service usage can then be compared with the distribution of alternative local taxes, specifically the existing rates system and the poll tax. It is argued that the most appropriate comparisons are between income and socio-economic groups standardised for demographicstructure, and the treatment of rebates is also considered. The article concludes that the poll tax incidence deviates systematically from the pattern of service usage and is therefore not a good benefit tax, worse in fact than the current rating system.

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Essays in honour of Howard Glennerster

Social policy is now central to political debate in Britain. What has been achieved by efforts to improve services and reduce poverty? What is needed to deliver more effective and popular services to all and increase social justice? How can we make social policy work? These are some of the questions discussed in this new and wide-ranging collection of essays by a distinguished panel of leading social policy academics.

The book covers key issues in contemporary social policy, particularly concentrating on recent changes. It examines the history and goals of social policy as well as its delivery, focusing in turn on the family and the state, schools, higher education, healthcare, social care, communities and housing. Redistribution is also examined, exploring child poverty, pension reform and resources for welfare.

The essays in this collection have been specially written to honour the 70th birthday of Howard Glennerster whose pioneering work has been concerned not only with the theoretical, historical and political foundations of social policies but, crucially, with how they work in practice. It is a collection of primary importance for those working in and interested in policy and politics in a wide variety of fields and for students of social policy, public policy and the public sector.

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This introductory chapter begins by briefly setting out the focus of the book, namely contemporary issues, particularly on the ways in which social policy in Britain has been reshaped in the first decade of the 21st century, the arguments that lay behind those changes, and the issues that they raise for the future evolution of policy. This is followed by overview of the subsequent chapters. The ingredients that make policy work and the work of Howard Glennerster are discussed.

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A country’s social policy reflects its values, hence identifying its ideological framework is important in determining, understanding, and anticipating a country’s position on social policy. In the United Kingdom, belief in the autonomy of the individual, the need to protect and assist the vulnerable, and a focus on economic growth to provide opportunity for all defines the role of government. It is through this framework that the UK considers domestic and European Community policies. This chapter discusses European social policy from the UK perspective. The first section discusses some of the fundamental differences between the European social model and the UK social model, and discusses how these stimulate and affect the UK’s basic attitudes towards European policy. The second section describes the recent changes and reforms in the UK policy and then discusses how the European and other international models have influenced its changes and reforms. The last section summarises the national responses to EU social policy initiatives.

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