Beyond the market in public service

Abstract

Critiques of the implementation of a market in health care have so far concentrated on conceptual, practical and ethical objections. it is not a real market, say the theorists; it is not delivering say the realists; it does not have public consent, say the moralists. Argues, from a more fundamental critique: the implementation of the market confuses means with ends. Problems lie not in the introduction of the market ‐ which, is argued, has served well in breaking up the frozen paradigm of the welfare state ‐ but in seeing it as an end state rather than a transition. Posits that this has left us trapped in a scenario about buildings, about restructuring and about contracts instead of resolving chronic human problems of ill health. Postulates that the issue is not to argue for or against the market, or indeed to set it against the alternative of the old welfare state: rather to ask how to learn from this transitional state and how to create the mixed economy which lies beyond both market and welfare state. Drawing on previous work on professional bureaucracies, markets and networks relocates the primary challenge not in managing the market but in meeting need within the remit of public consent.

Citation

James, A. (1997), "Beyond the market in public service", Journal of Management in Medicine, Vol. 11 No. 1, pp. 43-50. https://doi.org/10.1108/02689239710159044