Making Markets in the English National Health Service

Many commentators point to the rise of markets in public services such as healthcare. However, the conventional ‘similarity’ thesis has been challenged by the ‘difference’ thesis. This article critiques and extends the analysis of a recent contribution by Jane Gingrich to the ‘difference thesis’ with a more detailed case study of the English National Health Service (NHS). It argues that the text tends to ignore earlier models and other associated variables; provides a rather crude monolithic characterization of ‘left’ and ‘right’; and assumes rather than demonstrates strategic choice. It modifies some of her major conclusions: markets in public services matter (correct); markets vary in profound and important ways (correct, but perhaps in other ways); and partisan politics are central to explaining and shaping markets (perhaps over‐stated). While Gingrich's ‘breadth’ account is persuasive at the macro‐level, some questions arise from a more detailed account of the English NHS. First, it is not certain that Gingrich's typology is based on the most important dimensions. Second, her account tends to under‐state the importance of issues such as the nature of contracts, price competition, regulation and policies such as Private Finance Initiative. Third, it is not clear that the Conservative healthcare market can be characterized as an Austerity Market, and the Labour market as a Consumer‐Controlled Market. Fourth, this static characterization under‐states the degree of change between and within governments. Lastly, it is not clear what type of market the coalition government has introduced, but this hybrid type may be marked more by policy learning than ideology.