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The Other Invisible Hand:
Delivering Public Services through Choice and Competition
Julian Le Grand
Afterwords by Alain Enthoven and Lord David Lipsey

Paperback | 2007 | $59.95 | £49.95 | ISBN: 9780691129365
208 pp. | 5 1/2 x 8 1/2
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eBook | ISBN: 9781400828005 |
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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.


"This book is the bee's knees. Slender though it may be, it is one of the finest discussions of the dilemmas of and possibilities for the public services published in the past ten years."--Anthony Giddens, Times Higher Education Supplement

"Anyone interested in a succinct, engaging account of new ideas for public service modernization in the UK, in health and education particularly, will race through Julian Le Grand's latest book.... While the style is light, the thinking is certainly not simplistic. This is not an argument for the privatization of public services or the nonchalant handing out of money to patients or parents to fend for themselves on health and education. Nor is it, thankfully, concerned with the method of raising finance for health, which can often distract from other policy issues. It is, rather, about harnessing the positive aspects of competition between providers and choice for users. The purpose is to support interlinked social goals of equity, efficiency, improved health outcomes, social cohesion, the avoidance of segregation and better social mobility."--Mary Harney, Irish Times

"For a spirited defence of the role of choice-and-competition in the public service delivery mix, you will not find a better book than Le Grand's."--Robert E. Goodin, Public Policy

"[T]he book provides a lively, and well written polemic that should be widely consulted particularly by those who are skeptical about the merits of a market approach to social welfare."--James Midgley, Journal of Sociology and Social Welfare


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Table of Contents:

Acknowledgements ix
CHAPTER ONE: Ends and Means 6
CHAPTER TWO: Choice and Competition 38
CHAPTER THREE: School Education 63
CHAPTER FOUR: Health Care 94
CHAPTER FIVE: New Ideas 127
CHAPTER SIX: The Politics of Choice 156
AFTERWORDS: Alain Enthoven: An American Perspective 169
David Lipsey: A Sceptic's Perspective 174
Further Reading 180
Bibliography 183

This book has been translated into:

  • Japanese

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