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Agency and incentives in the NHS internal market

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  • Propper, Carol

Abstract

This paper presents and assesses the structure of incentives created by the 1991 reforms to the U.K. National Health System. It argues that these reforms created a set of overlapping principal-agent relationships, in which the ownership of assets and the division of rewards from use of these assets is unclear. This lack of clarity and the form of performance monitoring used by the government as principal in these agency relationships seem likely to give limited incentives for improvements in efficiency in the medium term. The paper discusses possible means to improve incentives.

Suggested Citation

  • Propper, Carol, 1995. "Agency and incentives in the NHS internal market," Social Science & Medicine, Elsevier, vol. 40(12), pages 1683-1690, June.
    • Handle: RePEc:eee:socmed:v:40:y:1995:i:12:p:1683-1690
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    Citations

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    Cited by:

    1. Paula González, 2005. "On a policy of transferring public patients to private practice," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 513-527, May.
    2. Bernard Dowling & Rod Sheaff & Susan Pickard, 2008. "Governance Structures and Accountability in Primary Care," Public Money & Management, Taylor & Francis Journals, vol. 28(4), pages 215-222, August.
    3. Rowena Jacobs & Diane Dawson, 2003. "Hospital efficiency targets," Health Economics, John Wiley & Sons, Ltd., vol. 12(8), pages 669-684, August.
    4. Brian Ferguson, 1996. "Progress of the UK health reforms and the role of information: what can the "dismal science" contribute?," Working Papers 145chedp, Centre for Health Economics, University of York.
    5. Xeni Dassiou & Peter Langham & Charles Nancarrow & Alex Scharaschkin & Dan Ward, 2015. "Public service markets: their economics, institutional oversight and regulation," Palgrave Communications, Palgrave Macmillan, vol. 1(palcomms2), pages 15035-15035, November.
    6. Carol Propper, 2005. "Why economics is good for your health. 2004 Royal Economic Society Public Lecture," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 987-997, October.
    7. Maria Alice Moz-Christofoletti & Paula Carvalho Pereda, 2021. "Winners and losers: the distributional impact of a carbon tax in Brazil," Working Papers, Department of Economics 2021_08, University of São Paulo (FEA-USP).
    8. Daniel Rey Aldana & Francisco Reyes Santias & Pilar Mazón Ramos & Manuel Portela Romero & Sergio Cinza Sanjurjo & Belén Álvarez Álvarez & Rosa Agra Bermejo & Francisco Gude Sampedro & José R. González, 2021. "Cost and Potential Savings of Electronic Consultation and Its Relationship with Reduction in Atmospheric Pollution," Sustainability, MDPI, vol. 13(22), pages 1-16, November.
    9. Propper, Carol, 1996. "Market structure and prices: The responses of hospitals in the UK National Health Service to competition," Journal of Public Economics, Elsevier, vol. 61(3), pages 307-335, September.
    10. Lise Rochaix, 1997. "Asymétries d'information et incertitude en santé : les apports de la théorie des contrats," Économie et Prévision, Programme National Persée, vol. 129(3), pages 11-24.
    11. James Lomas & Stephen Martin & Karl Claxton, 2018. "Estimating the marginal productivity of the English National Health Service from 2003/04 to 2012/13," Working Papers 158cherp, Centre for Health Economics, University of York.
    12. Paul Anand & Mark Exworthy & Francesca Frosini & Lorelei Jones, 2012. "Autonomy and improved performance: lessons from an NHS policy reform," Public Money & Management, Taylor & Francis Journals, vol. 32(3), pages 209-216, May.
    13. Peter C. Smith & Andrew Street, 2012. "Concepts and Challenges in Measuring the Performance of Health Care Organizations," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 32, Edward Elgar Publishing.
    14. Propper, Carol & Wilson, Deborah & Soderlund, Neil, 1998. "The effects of regulation and competition in the NHS internal market: the case of general practice fundholder prices," Journal of Health Economics, Elsevier, vol. 17(6), pages 645-673, December.
    15. Vining, Aidan R. & Globerman, Steven, 1999. "Contracting-out health care services: a conceptual framework," Health Policy, Elsevier, vol. 46(2), pages 77-96, January.
    16. Martin, Stephen & Smith, Peter C., 1999. "Rationing by waiting lists: an empirical investigation," Journal of Public Economics, Elsevier, vol. 71(1), pages 141-164, January.
    17. Carol Propper, 2001. "Expenditure on healthcare in the UK: a review of the issues," Fiscal Studies, Institute for Fiscal Studies, vol. 22(2), pages 151-183, June.

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