Governments spend huge amounts of public money on public services such as health, education, and social care, and yet the services that are delivered are often low quality, inefficiently run, and inequitable in their distribution. This book argues that the solution is to offer choice to users and to encourage competition among providers.

Acknowledgements ix INTRODUCTION 1 CHAPTER ONE: Ends and Means 6 CHAPTER TWO: Choice and Competition 38 CHAPTER THREE: School Education 63 CHAPTER FOUR: Health Care 94 CHAPTER FIVE: New Ideas 127 CHAPTER SIX: The Politics of Choice 156 AFTERWORDS: Alain Enthoven: An American Perspective 169 David Lipsey: A Sceptic's Perspective 174 Further Reading 180 Bibliography 183

"This book is the bee's knees. Slender though it may be, it is one of the finest discussions of the dilemmas of and possibilities for the public services published in the past ten years."--Anthony Giddens, Times Higher Education Supplement "Anyone interested in a succinct, engaging account of new ideas for public service modernization in the UK, in health and education particularly, will race through Julian Le Grand's latest book... While the style is light, the thinking is certainly not simplistic. This is not an argument for the privatization of public services or the nonchalant handing out of money to patients or parents to fend for themselves on health and education. Nor is it, thankfully, concerned with the method of raising finance for health, which can often distract from other policy issues. It is, rather, about harnessing the positive aspects of competition between providers and choice for users. The purpose is to support interlinked social goals of equity, efficiency, improved health outcomes, social cohesion, the avoidance of segregation and better social mobility."--Mary Harney, Irish Times "For a spirited defence of the role of choice-and-competition in the public service delivery mix, you will not find a better book than Le Grand's."--Robert E. Goodin, Public Policy "[T]he book provides a lively, and well written polemic that should be widely consulted particularly by those who are skeptical about the merits of a market approach to social welfare."--James Midgley, Journal of Sociology and Social Welfare

"Le Grand's main themes revolve around the provision of genuine choice to users of public services and the incentives for improved service delivery that such provision puts in place. Provision of choice to users—especially in health and education—is controversial, partly because of doubts about user ignorance and because it runs in the face of professional norms. Le Grand delivers a very persuasive case in favor of user choice. This is a wise, imaginative, and eminently readable book."—Geoffrey Brennan, Australian National University"This book provides a great introduction to the crucial debate about choice in public services. Julian Le Grand makes a strong case that choice can be both more efficient and more equitable as a means of delivering public services."—Simon Burgess, University of Bristol

Le Grand's main themes revolve around the provision of genuine choice to users of public services and the incentives for improved service delivery that such provision puts in place. Provision of choice to users--especially in health and education--is controversial, partly because of doubts about user ignorance and because it runs in the face of professional norms. Le Grand delivers a very persuasive case in favor of user choice. This is a wise, imaginative, and eminently readable book. -- Geoffrey Brennan, Australian National University This book provides a great introduction to the crucial debate about choice in public services. Julian Le Grand makes a strong case that choice can be both more efficient and more equitable as a means of delivering public services. -- Simon Burgess, University of Bristol