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Managed competition, governmentality and institutional response in the United Kingdom

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  • Light, Donald W.

Abstract

This article traces the use of managed competition policy to transform the NHS from an administered public service to a set of interlocking markets and contracts. It reviews the overlooked origins of managed competition in the new managerialism and explains the relationship between managed competition and the cost crisis of the NHS by extending Foucault's concept of governmentality to revise the concept of the state. The paper then describes how the government structured health care markets, using managed competition as an instrument of governmentality. It summarises institutional responses by health authorities, hospital trusts, and GP fundholders. The terms "master institution", "dictated competition" and "coercive partnering" are introduced as new concepts for economic sociology and as strategies of governmentality. Implementation, however, led to resistance, opposition and eventual abandonment of managed competition as too disruptive and costly. Yet , this analysis contends, managed competition has left an enduring legacy of accountability to purchasers in economic terms such as efficiency, transaction costs, and cost effectiveness. The policies of the new government are based on coercive partnering and doctor-based "commissioning". This and the Internet imply revolutionary changes for the health professions and the delivery of health care services through networks of moebius-strip organisations interacting in flexible sequences and subject to communication Pressures.

Suggested Citation

  • Light, Donald W., 2001. "Managed competition, governmentality and institutional response in the United Kingdom," Social Science & Medicine, Elsevier, vol. 52(8), pages 1167-1181, April.
    • Handle: RePEc:eee:socmed:v:52:y:2001:i:8:p:1167-1181
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    Citations

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    Cited by:

    1. Margaret Denton & Isik Zeytinoglu & Karen Kusch & Sharon Davies, 2007. "Market-Modelled Home Care: Impact on Job Satisfaction and Propensity to Leave," Canadian Public Policy, University of Toronto Press, vol. 33(s1), pages 81-99, January.
    2. Westra, Daan & Angeli, Federica & Carree, Martin & Ruwaard, Dirk, 2017. "Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective," Health Policy, Elsevier, vol. 121(2), pages 149-157.
    3. Triantafillou, Peter, 2014. "Against all odds? Understanding the emergence of accreditation of the Danish hospitals," Social Science & Medicine, Elsevier, vol. 101(C), pages 78-85.
    4. Jane Aronson & Sheila M. Neysmith, 2006. "Obscuring the costs of home care: restructuring at work," Work, Employment & Society, British Sociological Association, vol. 20(1), pages 27-45, March.
    5. Skinner, Mark W. & Rosenberg, Mark W., 2006. "Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario," Social Science & Medicine, Elsevier, vol. 63(11), pages 2864-2876, December.
    6. Dolfsma, W.A. & Finch, J. & McMaster, R., 2004. "Market and Society: How do they relate, and contribute to welfare?," ERIM Report Series Research in Management ERS-2004-105-ORG, Erasmus Research Institute of Management (ERIM), ERIM is the joint research institute of the Rotterdam School of Management, Erasmus University and the Erasmus School of Economics (ESE) at Erasmus University Rotterdam.
    7. Hussey, P. & Anderson, G. F., 2003. "A comparison of single- and multi-payer health insurance systems and options for reform," Health Policy, Elsevier, vol. 66(3), pages 215-228, December.
    8. Mascia, Daniele & Di Vincenzo, Fausto & Cicchetti, Americo, 2012. "Dynamic analysis of interhospital collaboration and competition: Empirical evidence from an Italian regional health system," Health Policy, Elsevier, vol. 105(2), pages 273-281.
    9. Krachler, Nick & Greer, Ian, 2015. "When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act," Social Science & Medicine, Elsevier, vol. 124(C), pages 215-223.
    10. Randall, Glen E. & Williams, A. Paul, 2006. "Exploring limits to market-based reform: Managed competition and rehabilitation home care services in Ontario," Social Science & Medicine, Elsevier, vol. 62(7), pages 1594-1604, April.
    11. Theobald, Hildegard, 2004. "Entwicklung des Qualifikationsbedarfs im Gesundheitssektor: Professionalisierungsprozesse in der Physiotherapie und Dentalhygiene im europäischen Vergleich," Discussion Papers, Research Unit: Labor Market Policy and Employment SP I 2004-104, WZB Berlin Social Science Center.
    12. Harris, Rebecca & Mosedale, Sarah & Garner, Jayne & Perkins, Elizabeth, 2014. "What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model," Social Science & Medicine, Elsevier, vol. 108(C), pages 54-59.

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