Making Markets in the E nglish N ational H ealth S ervice

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 J ane G ingrich to the ‘difference thesis’ with a more detailed case study of the E nglish N ational H ealth S ervice ( 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 G ingrich's ‘breadth’ account is persuasive at the macro‐level, some questions arise from a more detailed account of the E nglish NHS . First, it is not certain that G ingrich'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 P rivate F inance I nitiative. Third, it is not clear that the Conservative healthcare market can be characterized as an A usterity M arket, and the Labour market as a C onsumer‐ C ontrolled M arket. 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.