Showing papers by "Julian Le Grand published in 2003"

Motivation, agency, and public policy : of knights and knaves, pawns and queens

Abstract: Preface 1. Introduction: Motivation, Agency, and Public Policy PART I: THEORY: FROM KNAVE TO KNIGHT 2. Knights and Knaves in the Public Sector: What do we Mean and What do we Know? 3. Motivation and the Public Context 4. Knight and Knave: A Theory of Public Service Motivation PART II: FROM PAWN TO QUEEN 5. Agency and Public Services 6. Agency and Public Finance PART III: POLICY 7. Health Care 8. School Education 9. A Demogrant 10. Partnership Savings 11. Hypothecation Epilogue: Doux Commerce Publique

Is the NHS equitable?: a review of the evidence

Abstract: All rights reserved. No part of this paper may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this publication is available from the British Library. The central question of the paper is whether the NHS is inequitable and if so, what form the inequity takes and what are its principal causes. The paper begins with a brief discussion of the meaning of equity in the context of the NHS. The definition adopted regards observed inequalities in utilisation as proxies for inequalities in access. The paper reviews the available evidence on the existence of inequity in the NHS from macro-studies and micro-studies. Evidence from macro-or aggregate studies is not clear-cut. Early studies showed utilisation by higher income groups was higher than lower income groups adjusted for need. More recent studies using similar aggregated data suggest that this pattern has changed and the NHS is now pro-poor. However, a study using more disaggregated data and the majority of the micro-studies suggest that inequities in access persist. There is strong evidence that lower socioeconomic groups use services less in relation to need than higher ones from many studies of specific NHS services. An attempt is made to explain the conflict through an assessment of the methodologies and data used. Finally, the paper discusses the evidence concerning potential barriers to access such as lack of suitable transport and restrictions on time; superior connections and communications by middle class patients; and differences in beliefs about severity of illness and the need to seek medical attention. The paper concludes that policy-makers need to understand these barriers to access when devising policy aimed at eliminating persisting inequities in access identified in this review. Acknowledgements: We would like to thank Franco Sassi for his comments. The views expressed in this paper are those of the authors and not necessarily those of the Department of Health or the No 10 Policy Unit.

Individual choice and social exclusion

Abstract: Why is social exclusion a problem? What about ‘voluntary’ social exclusion – when an individual chooses to exclude him or herself from the wider society? Brain Barry has addressed these questions in a recent CASE book, arguing that social exclusion, voluntary or involuntary, offends against social justice and social solidarity. This paper contends that Barry’s arguments are weak for voluntary social exclusion and argues that, perhaps surprisingly, a better case can be made for treating voluntary social exclusion as a problem on welfarist grounds.

Complementary and alternative medicine in the UK and Germany - research and evidence on supply and demand

Abstract: Through its work in Germany and in the United Kingdom, the Anglo-German Foundation seeks to foster dialogue and cooperation between the two countries. It supports research projects, seminars and conferences promoting the exchange of experience and ideas in the social, political and economic areas. Die Deutsch-Britische Stiftung möchte mittels ihrer Tätigkeit in Deutschland und Grossbritannien den Dialog und die Zusammenarbeit der beiden Staaten fördern. Sie unterstützt gemeinsame Forschungsprojekte, Seminare und Konferenzen und setzt sich dabei besonders für den Erfahrungs-und Ideenaustausch im sozialen, politischen und wirtschaftlichen Bereich ein.

Individual choice and social exclusion

Abstract: Why is social exclusion a problem? What about ‘voluntary’ social exclusion – when an individual chooses to exclude him or herself from the wider society? Brain Barry has addressed these questions in a recent CASE book, arguing that social exclusion, voluntary or involuntary, offends against social justice and social solidarity. This paper contends that Barry’s arguments are weak for voluntary social exclusion and argues that, perhaps surprisingly, a better case can be made for treating voluntary social exclusion as a problem on welfarist grounds.

Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens

Abstract: 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.

A Capital Idea: Helping the Young to Help Themselves

Abstract: This chapter discusses the idea of a capital grant that has received widespread attention in recent years.2 It suggests that each individual, on attaining the age of majority, should receive a grant of capital that he or she can use as a springboard to accumulate wealth. The grant would be financed by funds from a new tax on inheritance. In that way the accumulated wealth of one generation would fertilize the development of the next.

Primary care organisations and the 'modernisation' of the NHS

Abstract: The 'modernization' of the NHS is at the heart of the UK government's policies for public sector services. This modernization programme represents the most radical and ambitious restructuring of the NHS since its inception in 1948. The new Primary Care Groups and Trusts (PCG/Ts) are the main organizational mechanism for delivering the modernization agenda and are therefore key to the success or otherwise of these reforms. To date there has been no comprehensive evaluation of how PCG/Ts have been performing in implementing the modernization programme; this book fills that important gap in knowledge. It provides a strong text of first evidence about the performance of PCG/Ts to date; this forms the basis for discussions about future success and a benchmark for future research.