Book contents
- Frontmatter
- Contents
- List of figures
- List of tables
- List of boxes
- Notes on contributors
- Foreword
- 1 Introduction: knowledge and performance – theory and practice
- 2 Knowledge from inspection: external oversight and information to improve performance
- 3 How is information used to improve performance in the public sector? Exploring the dynamics of performance information
- 4 Citizens, users or consumers: the voice of the public and its influence on improving performance
- 5 Competition and choice: the place of markets in connecting information and performance improvement
- 6 The role of corporate governance and boards in organisational performance
- 7 Change at the top: connecting political and managerial transitions with performance
- 8 The role of leadership in knowledge creation and transfer for organisational learning and improvement
- 9 Process Improvement and Lean Thinking: using knowledge and information to improve performance
- 10 Using evidence: how social research could be better used to improve public service performance
- 11 Absorptive capacity: how organisations assimilate and apply knowledge to improve performance
- 12 Knowing through doing: unleashing latent dynamic capabilities in the public sector
- 13 Conclusions: a puzzle, three pieces, many theories and a problem
- Index
- References
5 - Competition and choice: the place of markets in connecting information and performance improvement
Published online by Cambridge University Press: 05 July 2011
Book contents
- Frontmatter
- Contents
- List of figures
- List of tables
- List of boxes
- Notes on contributors
- Foreword
- 1 Introduction: knowledge and performance – theory and practice
- 2 Knowledge from inspection: external oversight and information to improve performance
- 3 How is information used to improve performance in the public sector? Exploring the dynamics of performance information
- 4 Citizens, users or consumers: the voice of the public and its influence on improving performance
- 5 Competition and choice: the place of markets in connecting information and performance improvement
- 6 The role of corporate governance and boards in organisational performance
- 7 Change at the top: connecting political and managerial transitions with performance
- 8 The role of leadership in knowledge creation and transfer for organisational learning and improvement
- 9 Process Improvement and Lean Thinking: using knowledge and information to improve performance
- 10 Using evidence: how social research could be better used to improve public service performance
- 11 Absorptive capacity: how organisations assimilate and apply knowledge to improve performance
- 12 Knowing through doing: unleashing latent dynamic capabilities in the public sector
- 13 Conclusions: a puzzle, three pieces, many theories and a problem
- Index
- References
Summary
Introduction
The ‘invisible hand’ of competition is a common textbook mechanism for improving performance. Provided there is sufficient information, the autonomous choices of individuals will improve efficiency of provision. The competitive pressure consumer choice creates helps make private firms more efficient, and they cut costs and improve their goods or services in order to attract customers. Is the same true in the context of public services such as healthcare and education? It seems easy to transfer the logic to the provision of public services. Giving service users the ability to choose applies competitive pressure to public service providers and, analogously with private markets, they will raise their performance to attract (or retain) clients. The aim of this chapter is to subject this assumption to the scrutiny provided by both the theoretical and empirical economic evidence on choice and competition in the healthcare and education sectors.
Extending competition between public service providers is currently a popular policy, in the UK and elsewhere. In the UK public sector some form of competition has been present since the quasi-market reforms of the late 1980s (Bartlett et al. 1994), which emphasised competition between service providers. More recently the policy discourse has focused more on increasing direct consumer choice (Le Grand 2007). The key question we address is whether policies that promote market-like pressures create the incentives for hospitals and schools to improve their performance and, if so, under what circumstances. What may be other, possibly less desired outcomes, and why?
Information
- Type
- Chapter
- Information
- Connecting Knowledge and Performance in Public ServicesFrom Knowing to Doing, pp. 74 - 98Publisher: Cambridge University PressPrint publication year: 2010
References
(2008). Is the Treatment Working? Progress with the NHS System Reform Programme, www.audit-commission.gov.uk (accessed 15 October 2008).
(2003). Class Strategies and the Education Market: The Middle Class and Social Advantage. London: RoutledgeFarmer.CrossRefGoogle Scholar
and (2002). ‘The Effect of the Quasi-market on the Efficiency–Equity Trade-off in the Secondary School Sector’, Bulletin of Economic Research 54(3): 295–314.CrossRefGoogle Scholar
, , and (2000). ‘Testing for Quasi-market Forces in Secondary Education’, The Oxford Bulletin of Economics and Statistics 62(3): 357–90.CrossRefGoogle Scholar
and (2006). School Assignment, School Choice and Social Mobility. CMPO Discussion Paper 06/157, CMPO: University of Bristol.Google Scholar
and (2005). Using Boundary Changes to Estimate the Impact of School Competition on Test Scores. CMPO Discussion Paper 06/158, CMPO: University of Bristol.Google Scholar
, and (2002). Does Performance Monitoring Work? A Review of the Evidence from the UK Public Sector, Excluding Health Care. CMPO Discussion Paper 02/49, CMPO: University of Bristol.Google Scholar
, , and (2005). Background Facts for School Choice in England. CMPO Discussion Paper 06/159, CMPO: University of Bristol.Google Scholar
, , and (2004). ‘The Impact of School Choice on Sorting by Ability and Socio-economic Factors in English Secondary Education’, in and (eds.), Schools and the Equal Opportunity Problem. Cambridge, MA: MIT Press.Google Scholar
, and (1998). ‘Insurance Type and Choice of Hospital for Coronary Artery Bypass Graft Surgery’, Health Services Research 33(3): 447–66.Google Scholar
(2004). Politics, Markets and Schools: Quasi-experimental Evidence on the Impact of Autonomy and Competition from a Truly Revolutionary UK Reform. Mimeo, University of California: Berkeley.Google Scholar
(1998). Public School Segregation in Metropolitan Areas. NBER Working Paper 6779, Cambridge, MA: NBER.CrossRefGoogle Scholar
(2006). ‘MPs Give Independent Treatment Centres a Poor Report’, British Medical Journal, 29 July.CrossRefGoogle Scholar
and (2006). ‘Hospital Competition and Patient Choice in Publicly Funded Health Care’, in (ed.), The Elgar Companion to Health Economics. Cheltenham: Edward Elgar.Google Scholar
, and (2001). ‘Do Doctors Respond to Financial Incentives? UK Family Doctors and the GP Fundholder Scheme’, Journal of Public Economics 79(2): 375–98.CrossRefGoogle Scholar
, and (2000). The Impact of School Choice on Student Outcomes: An Analysis of the Chicago Public Schools. NBER Working Paper 7888, Cambridge, MA: NBER.CrossRefGoogle Scholar
, and (2003). The Effect of School Choice on Student Outcomes: Evidence from Randomised Lotteries. NBER Working Paper 10113, Cambridge, MA: NBER.CrossRefGoogle Scholar
(2002). ‘Incentives and Organizations in the Public Sector: An Interpretive Review’, Journal of Human Resources 37(4): 696–727.CrossRefGoogle Scholar
and (2000). ‘The Industrial Organization of Health Care Markets’, in and (eds.), Handbook of Health Economics. Amsterdam: North Holland.Google Scholar
, , and (2003). ‘Is More Information Better? The Effects of Report Cards on Health Care Providers’, Journal of Political Economy 111(3): 555–88.CrossRefGoogle Scholar
, and (2004). ‘The Effect of Practice Budgets on Patient Waiting Time: Allowing for Selection Bias’, Health Economics 13: 941–58.CrossRefGoogle Scholar
(1998). ‘Creaming, Skimping and Dumping: Provider Care on the Intensive and Extensive Margins’, Journal of Health Economics 17: 537–55.CrossRefGoogle Scholar
and (2003). ‘Neighbourhood Schools, Choice, and the Distribution of Educational Benefits’, in (ed.), The Economics of School Choice. University of Chicago Press.Google Scholar
, , , et al. (1999). ‘Health Maintenance Organizations and Hospital Quality for Coronary Artery Bypass Surgery’, Medical Care Research and Review 56(3): 340–62.CrossRefGoogle Scholar
(2004). Improving Health Care: A Dose of Competition. Washington, DC: Federal Trade Commission and Department of Justice.Google Scholar
and (2006). ‘Do Accountability and Voucher Threats Improve Low-performing Schools?’Journal of Public Economics 90(1–2): 239–55.CrossRefGoogle Scholar
(2004). Competition and Quality in Health Care Markets: What Do We Know, What Don't We Know? Paper commissioned by the Federal Trade Commission, mimeo, Department of Public Policy, Carnegie Mellon University, Pittsburgh.Google Scholar
and (2000). ‘Antitrust and Competition in Health Care Markets’, in and (eds.), Handbook of Health Economics. Amsterdam: North Holland.Google Scholar
, , and (1999). ‘Internal Markets and Efficiency in Health Care: A Multiple Output Stochastic Frontier Analysis’, Health Economics 8: 151–64.3.0.CO;2-Q>CrossRefGoogle Scholar
, and (2008). ‘Choice, Competition and Pupil Achievement’, Journal of the European Economic Association 6(4): 912–47.CrossRefGoogle Scholar
and (2003). ‘Competition, Payers and Hospital Quality’, Health Services Research 38: 1403–21.CrossRefGoogle Scholar
, , , and (2008). How Important is Pro-social Behaviour in the Delivery of Public Services?CMPO Discussion Paper 08/197, CMPO: University of Bristol.Google Scholar
(1992). The Effect of Price Shopping in Medical Markets: Hospital Responses to PPOs in California. NBER Working Paper 4190.CrossRefGoogle Scholar
and (2000). ‘Hospital Mergers and Acquisitions: Does Market Consolidation Harm Patients?’, Journal of Health Economics 19(5): 767–91.Google Scholar
, , Jr., , and (1994). ‘Improving the Outcomes of Coronary Artery Bypass Surgery in New York State’, Journal of the American Medical Association 271: 761–6.CrossRefGoogle Scholar
(2000). ‘Does Competition among Public Schools Benefit Students and Taxpayers?’, American Economic Review 90(5): 1209–38.CrossRefGoogle Scholar
(2003a). ‘School Choice and School Competition: Evidence from the United States’, Swedish Economic Policy Review 10: 11–67.Google Scholar
(2003b). ‘Introduction’, in (ed.), The Economics of School Choice. University of Chicago Press.CrossRefGoogle Scholar
(2003c). ‘School Choice and School Productivity: Could School Choice be a Tide that Lifts all Boats?’, in (ed.), The Economics of School Choice. University of Chicago Press.CrossRefGoogle Scholar
(2005). Competition among Public Schools: A Reply to Rothstein. NBER Working Paper 11216, Cambridge, MA:NBER.CrossRefGoogle Scholar
and (2003). The Effects of Hospital Competition on Variation in Utilization and Quality of Care, presented at Agency for Healthcare Research and Quality/Federal Trade Commission Provider Competition and Quality Conference, 28 May.
and (2000). ‘Is Hospital Competition Socially Wasteful?’, Quarterly Journal of Economics 115(2): 577–616.CrossRefGoogle Scholar
(2002). ‘School Vouchers: A Critical View’, Journal of Economic Perspectives 16(4): 3–24.CrossRefGoogle Scholar
(2003). ‘Comment on Caroline Hoxby: School Choice and Competition: Evidence from the United States’, Swedish Economic Policy Review 10: 67–76.Google Scholar
and (2001). ‘The Uneven Playing Field of School Choice: Evidence from New Zealand’, Journal of Policy Analysis and Management 20(1): 43–64.3.0.CO;2-4>CrossRefGoogle Scholar
(1997). ‘Knights, Knaves or Pawns? Human Behaviour and Social Policy’, Journal of Social Policy 26(2): 149–69.CrossRefGoogle Scholar
(1999). ‘Competition, Co-operation or Control – Tales from the British National Health Service’, Health Affairs 18(3): 27–39.CrossRefGoogle Scholar
(2007). The Other Invisible Hand: Delivering Public Services Through Choice and Competition. Woodstock, UK: Princeton University Press.Google Scholar
(2002). The Publication of Performance Data in the National Health Service, available at: www.chi.nhs.uk/eng/ratings/academic_papers/index.shtml.
and (1994). ‘The Threat of “Cream Skimming” in the Post-reform NHS’, Journal of Health Economics 13(1): 31–60.CrossRefGoogle Scholar
(2004). ‘Competition, Incentives and Public School Performance’, Journal of Public Economics 88: 1871–92.CrossRefGoogle Scholar
, , et al. (2000). ‘Do Quality Report Cards Play a Role in HMOs’ Contracting Practices? Evidence from New York State', Health Services Research 35(1): 319–32.Google Scholar
(2002). ‘How Vouchers Could Change the Market for Education’, Journal of Economic Perspectives 16(4): 25–44.CrossRefGoogle Scholar
(1999). ‘School Finance Induced Migration Patterns: The Impact of Private School Vouchers’, Journal of Public Economic Theory 1(1): 5–50.CrossRefGoogle Scholar
(2003a). ‘Introducing School Choice into Multi-district Public School Systems’, in (ed.), The Economics of School Choice. University of Chicago Press.Google Scholar
(2003b). ‘School Finance, Spatial Income Segregation and the Nature of Communities’, Journal of Urban Economics 54(1): 61–88.CrossRefGoogle Scholar
(2004). ‘Income and Peer Quality Sorting in Public and Private Schools’, in and (eds.), Handbook of Economics of Education. Amsterdam: North Holland.Google Scholar
(2000). ‘Insurance Reimbursement’, in and (eds.) Handbook of Health Economics, Vol. 1 Part 1: 537–60. Amsterdam: North Holland.Google Scholar
, , and (2003). ‘School Vouchers: Results from Randomised Experiments’, in (ed.), The Economics of School Choice. University of Chicago Press.Google Scholar
(1996). ‘Market Structure and Prices: The Responses of Hospitals in the UK National Health Service to Competition’, Journal of Public Economics 61(3): 307–35.CrossRefGoogle Scholar
and (2003). ‘The Use and Usefulness of Performance Measures in the Public Sector’, Oxford Review of Economic Policy 19(2): 250–67.CrossRefGoogle Scholar
, and (2008). ‘Competition and Quality: Evidence from the NHS Internal Market 1991–99’, Economic Journal 118: 138–70.CrossRefGoogle Scholar
, and (2002). ‘Waiting Times for Hospital Admissions: The Impact of Fundholding’, Journal of Health Economics 21(2): 227–52.CrossRefGoogle Scholar
, and (1998). ‘The Effects of Regulation and Competition in the NHS Internal Market: The Case of General Practitioner Fundholder Prices’, Journal of Health Economics 17(6): 645–73.CrossRefGoogle Scholar
(2004). ‘Exclusivity, Exclusion and Social Class in Urban Education Markets in the United Kingdom’, Urban Education 39(5): 537–60.CrossRefGoogle Scholar
and (1985). ‘The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay and the Cost of Care’, Journal of Health Economics 4: 333–56.CrossRefGoogle Scholar
, and (2007). ‘Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions in California’, Health Services Research 42(2): 682–705.CrossRefGoogle Scholar
(2005). Does Competition Among Public Schools Benefit Students and Taxpayers? A Comment on Hoxby (2000). NBER Working Paper 11215, Cambridge, MA: NBER.CrossRefGoogle Scholar
(2006). ‘Good Principals or Good Peers? Parental Valuation of School Characteristics, Tiebout Equilibrium, and the Incentive Effects of Competition Among Jurisdictions’, American Economic Review 96(4): 1333–50.CrossRefGoogle Scholar
(1998). ‘Private School Vouchers and Student Achievement: An Evaluation of the Milwaukee Parental Choice Program’, Quarterly Journal of Economics 113(2): 553–602.CrossRefGoogle Scholar
and (2002). School Vouchers in Practice – Competition Won't Hurt You. IUI Working Paper Series 578, Stockholm: The Research Institute of Industrial Economics.Google Scholar
and (2007). ‘An Empirical Analysis of the Impact of Choice on Waiting Times’, Health Economics 16(8): 763–79.CrossRefGoogle Scholar
(2000). ‘Not for Profit Ownership and Hospital Behaviour’, in and (eds.), The Handbook of Health Economics. Amsterdam: North Holland, Vol. 1B: 1142–74.Google Scholar
(1995). ‘On the Unintended Consequences of Publishing Performance Data in the Public Sector’, International Journal of Public Administration 18(2/3): 277–310.CrossRefGoogle Scholar
, , , and (1997). ‘Impact of the NHS Reforms on English Hospital Productivity: An Analysis of the First Three Years’, British Medical Journal 315: 1126–9.CrossRefGoogle Scholar
and (2005). School Choice and Segregation, Evidence from an Admission Reform, Uppsala, Sweden: Institute for Labour Market Policy Evaluation, draft available at www.sofi.su.se/sem/SoderstromUusitalo.pdf.
(2003). ‘Assessing Competition in Hospital Care Markets: The Importance of Accounting for Quality Differentiation’, Rand Journal of Economics 34(4): 786–814.CrossRefGoogle Scholar
, , et al. (2003). ‘Market Reform in New Jersey and the Effect on Mortality from Acute Myocardial Infarction’, Health Services Research 38: 509–27.CrossRefGoogle Scholar
(2008). ‘Exit, Voice and Quality in the English Education Sector’. CMPO Discussion Paper 08/194, CMPO: University of Bristol.
(2000). The Market Approach to Education: An Analysis of America's First Voucher Program. Princeton University Press.Google Scholar
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