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The Other Invisible Hand
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.
eBook
Preventing childhood obesity
Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early
childhood mortality. Given this trajectory toward a healthier childhood, we
begin the 21st-century with a shocking development-an epidemic of obesity
in children and youth. The increased number of obese children
throughout the U.S. during the past 25 years has led policymakers to rank
it as one of the most critical public health threats of the 21st-century.
Preventing Childhood Obesity provides a broad-based examination of the
nature, extent, and consequences of obesity in U.S. children and youth,
including the social, environmental, medical, and dietary factors responsible
for its increased prevalence. The book also offers a prevention-oriented
action plan that identifies the most promising array of short-term and
longer-term interventions, as well as recommendations for the roles and
responsibilities of numerous stakeholders in various sectors of society to
reduce its future occurrence. Preventing Childhood Obesity explores the
underlying causes of this serious health problem and the actions needed to
initiate, support, and sustain the societal and lifestyle changes that can
reverse the trend among our children and youth.
eBook
Paths between peace and public service : a comparative analysis of public service reform trajectories in postconflict countries
Provides policy guidance on how to rebuild public services in postconflict settings. It conducts a comparative analysis of public service reform trajectories in five postconflict countries: Afghanistan, Liberia, Sierra Leone, South Sudan, and Timor-Leste.
Book
Saving America?
On January 29, 2001, President George W. Bush signed an executive order creating the White House Office of Faith-Based and Community Initiatives. This action marked a key step toward institutionalizing an idea that emerged in the mid-1990s under the Clinton administration--the transfer of some social programs from government control to religious organizations. However, despite an increasingly vocal, ideologically charged national debate--a debate centered on such questions as: What are these organizations doing? How well are they doing it? Should they be supported with tax dollars?--solid answers have been few.
eBook
Emergency department treatment of the psychiatric patient : policy issues and legal requirements
Many hospital emergency departments are overcrowded and short-staffed, with a limited number of available hospital beds. It is increasingly hard for emergency departments and their staff to provide the necessary level of care for medical patients. Caring for people with psychiatric disabilities raises different issues and calls on different skills. In Emergency Department Treatment of the Psychiatric Patient, the author uses research, surveys, and statutory and litigation materials to examine problems with emergency department care for clients with psychiatric disorders. She relies on interviews with emergency department nurses, doctors and psychiatrists, as well as surveys of people with psychiatric disabilities in order to present the perspectives of both the individuals seeking treatment, and those providing it. This book explores the structural pressures on emergency departments and identifies the burdens and conflicts that undermine their efforts to provide compassionate care to people in psychiatric crisis. In addition to presenting a new analysis of the source of these problems, the author also suggests alternatives to emergency department treatment for people in psychiatric crisis. Moreover, she proposes standards for treatment of these individuals when they do inevitably end up in a hospital emergency department.
eBook
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda.
166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics.
Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines.
The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health.
World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
Journal Article