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Essays on public services, markets, and intrinsic motivation

Skellern, Matthew (2014) Essays on public services, markets, and intrinsic motivation. PhD thesis, London School of Economics and Political Science.

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This thesis comprises three essays examining the roles of markets and intrinsic motivation in public organisations. Chapter 1 examines the impact of establishing Independent Sector Treatment Centres in the English National Health Service (NHS) during the 2000s on the performance of neighbouring NHS (public) hospitals. It finds that NHS hospitals that had an ISTC placed nearby became more efficient (measured using pre-surgical length of stay for orthopaedic surgery), but also received sicker patients on average, as ISTCs avoided treating the sickest patients. Average cost per patient at ISTC-exposed NHS hospitals increased, suggesting that any efficiency gains were swamped by the negative effect on costs of worsened patient casemix. Chapter 2 examines the 2006 introduction of patient choice of hospital for elective surgery within the English NHS, using Patient Reported Outcome Measures (PROMs) of health gain from surgery as a measure of hospital quality. The hospital competition brought about by this reform appears to have led to lower varicose vein surgery quality, but no change in groin hernia surgery quality. For orthopaedic surgery quality, the evidence in support of a negative effect of competition outweighs the evidence to the contrary. We explain these findings by explicitly modelling the hospital as a multi-product firm. Chapter 3 examines the rationale for the 2011 Busan Declaration, which states that foreign aid should be given in line with the priorities of recipients, by constructing a model of the interaction between donors and charitable entrepreneurs, where occupational choice is endogenous, donors can choose whether to give, and donors and entrepreneurs are paired in a stable matching. We show that mission conflict in the charitable sector can arise when mission preferences and income earnings ability in the private sector are correlated, and examine policy options to encourage the charitable sector to give greater weight to recipients’ objectives.

Item Type: Thesis (PhD)
Additional Information: © 2014 Matthew Skellern
Library of Congress subject classification: H Social Sciences > HB Economic Theory
Sets: Departments > Economics
Supervisor: Ghatak, Maitreesh

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