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

By Julian Le Grand | Go to book overview
Save to active project

7 Health Care

What is the use of discussing a man's abstract right to food or medicine? The question is upon the method or procuring and administering them.

(Edmund Burke, Reflections on the Revolution in France)

In Chapter Four I developed the proposition that, if policy-makers were largely ignorant about the exact form of the motivational structures of those who worked in the public sector, they should try to design policies that incorporate robust incentive structures: structures that align knightly and knavish motivations in a fashion that direct the individuals concerned towards producing the desired outcomes. Chapter Five argued that policies should also be designed so as to empower users of public services, on the assumption that users were queens not pawns. But it was also pointed out that there were problems concerning users' poor information base, their possible reasoning incapacity, and their potentially excessive use of the service concerned: problems that meant that unfettered user choice would not always be appropriate.

In this chapter and the next, I put some empirical flesh on the philosophical and economic bones of those arguments by discussing some specific policies in health care and education from their perspective. As noted in Chapter One , it is important to analyse specifics in this way: for only by so doing so can academic analysts escape the charge of avoiding the difficult decisions. So, for instance, it is relatively easy to say that we need robust incentive structures, or to say that user choice needs to be partly restrained; but it is much more difficult to specify what form the incentive structures or choice restrictions might take.

This chapter deals with health care and with two areas where these issues are important: the interface between primary and secondary care, and the payment of hospital specialists. Although the discussion is centred on British institutional structures, the problems addressed, as well as the proposed solutions to them, are of more general application.


PRIMARY AND SECONDARY HEALTH CARE

Many of the recent debates on the organisational structure of the British National Health Service (NHS) have concerned the issue of incentives,

-95-

Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this page

Cited page

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited page

Bookmark this page
Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen
/ 192

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?