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Zoltan's avatar

It is curious that in an article about the distorting effect of incentives, you say this, "You might object that such contracting out will improve the public services. I’ve no strong view on this: transactions cost economics is all about detail and context." But surely in most examples of contracted out public services the incentive for the provider is not to provide a good service - because that is too vague and difficult to measure - but rather to meet some simplistic targets which they can game - and always do.

I was once an information analyst in the NHS and the biggest problem we had was measuring what mattered most to patients - outcomes. We could provide endless statistics on referrals, length of stay, numbers of operations, time on waiting lists, number of day cases vs in-patient etc. etc. But, none of this told us whether after all the waiting, referrals, more waiting, operation and time in hospital, the outcome was positive for the patient. As in, they got better, or recovered from their ailment or problem. We could only indirectly get some indication by whether they had to come back within the next few months. So what really matters in a health system was more or less guess work, at least statistically speaking.

When contracting out such services they will set targets for time waiting, number of operations, and length of stay (or proportion of day cases) but there won't be targets for outcomes. This pattern is typical across services, because complex services involve interactions with people in circumstances that vary widely. There is no easy binary to count. Instead they look for things that are easy to count, and set these as targets. But these may have only a tangential relevance to what really matters to the service user.

The result is that the providers focus entirely on meeting the target, and not at all on delivering a good (as in, positive outcomes for the customers) service. The problem is compounded because the contract is between the provider and the so called purchaser, who is NOT the customer. Which automatically interrupts the feedback loop of buyer/seller that neoclassical economics so lauds.

I can say fairly categorically that in the Public Sector contracting out does NOT improve services. Nor is it really expected to. The real driver is fixing costs and defining budgets - preferably ones that get special funding. It rarely even saves money, because the providers quickly learn how to game it to extract the maximum, and often find they have the purchasers at a disadvantage because of the targets and the lack of direct interface between the paying customers (the government department or quango) and the actual service deliverers (who may even be contracters of a sub-contracted group, not even the of the original providers holding the contract). As it is all budget driven, should costs go up, the service will be squeezed, meaning the front-line staff and customers - but at least the blame is spread and so more easily dodged.

Chris Hale's avatar

Thoughtful and well researched article, gives me plenty with which to educate people. Thanks

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