Will Bartlett

Quasi‐markets and contracts: A markets and hierarchies perspective on NHS reform

Recent reforms in the organization of the National Health Service (NHS) have introduced market‐type relationships between purchasers and providers, based largely on long‐term contracts, in an attempt to improve the cost‐effectiveness of health service delivery. The proponents of the new arrangements argue that efficiency will be stimulated via the incentive effects of competition. However, any such gains from the introduction of quasi‐markets are likely to be offset by the substantial transaction costs associated with the operation of markets characterized by uncertainty, bounded rationality and imperfect information. This paper analyses the sources of the transaction costs which are likely to arise, in the context of the various types of contract design available to the new quasimarket in health service delivery.

Europe's Troubled Region : Economic Development, Institutional Reform, and Social Welfare in the Western Balkans

The countries of the Western Balkans - Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Serbia and the province of Kosovo - form a core European region. The region is known for its instability and recent history of wars and civil conflicts, but far less is known about the changes that have taken place in the economic and social welfare systems and the dynamic processes of transition, development and European integration that have been taking place over the last twenty years. Although economic growth has been firmly established, many problems remain in relation to the labour markets where there is high unemployment, large informal economies, and widespread poverty. The book discusses the role of welfare reforms, international aid and European integration in addressing these difficulties. The author argues that the resistance to reforms which were initiated under the communist system in former Yugoslavia led to the break up of the country and that since then a group of early reforming countries have made fast progress in institutional reform and have been at the forefront of EU integration. He also acknowledges that the main problems have been among a group of late reformers including two international protectorates where aid dependence has held back progress with institutional reforms. The book concludes that the resolution of these problems will unblock the completion of the transition, development and EU integration in the region and open for the way for a more stable and prosperous future.

Small Firms and Economic Transformation in Bulgaria

The pace of transition to a market economy has been slower in Bulgaria than in some other east European countries in the 1990s. Output levels in the state owned sector, which has not yet been subject to mass privatisation, have fallen sharply and there has been a dramatic increase in unemployment. There has however also been a rapid growth in the number of small firms, and the ability of this sector to generate new jobs will be an important component of labour market dynamics in the future. Some of the main characteristics of this emergent sector are identified on the basis of a sample survey of nearly 400 small Bulgarian firms, covering competitiveness, entrepreneurship, innovation, networking, labour relations and business performance of the small firms. Key features of a subset of small firms with an orientation towards employment growth are identified.

Does hospital ownership affect patient experience? An investigation into public-private sector differences in England.

Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hospital episode; (ii) selection into private hospitals; and (iii) unmeasured hospital characteristics captured by hospital fixed effects. We find that the experience reported by patients in public and private hospitals is different, i.e. most dimensions of quality are delivered differently by the two types of hospitals, with each sector offering greater quality in certain specialties or to certain groups of patients. However, the sum of all ownership effects is not statistically different from zero at sample means. In other words, hospital ownership in and of itself does not affect the level of quality of the average patients reported experience. Differences in mean reported quality levels between the private and public sectors are entirely attributable to patient characteristics, the selection of patients into public or private hospitals and unobserved characteristics specific to individual hospitals, rather than to hospital ownership.

Institutional constraints and SME growth in post-communist Albania

Purpose – This paper aims to investigate business growth in post-communist Albania using an institutional perspective. Design/methodology/approach – The paper takes an institutional perspective, which emphasises the role of institutional change in enabling/constraining business growth whilst allowing for entrepreneurial objectives and motivations to be taken into account. The analysis is based on firm-level data collected through a survey questionnaire in April-July 2004. The paper uses principal components analysis and a regression model to explain the factors that determine the pace of business growth of small firms. Findings – The analysis offers important insights into the nature of entrepreneurship in a post-communist setting. The age of the firm, the age, education, qualifications and work orientation of the entrepreneur, insufficient information and corruption, explain the differential growth of firms. Older entrepreneurs grow faster suggesting unfulfilled aspirations during communism as well as their access to wider professional, social and possibly also political connections. The positive effect of corruption on business growth suggests that an ability to cope with a corrupt environment has been a necessary entrepreneurial skill during a period of chaotic change in social and formal institutions that has characterized transition in Albania. Originality/value – This research can be of special interest to studies of entrepreneurship in institutional transformation contexts, and it contributes especially to the accumulation of knowledge on transition economies by looking at the little researched case of post communist Albania.

New forms of provider in the English National Health Service

A wide ranging set of reforms is being introduced into the English National Health Service (NHS). They are designed to increase the market-like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services. This paper is concerned with one aspect of those reforms: namely the policy to increase the diversity of types of providers of care to NHS patients. In this context, increasing diversity means that providers will not all be standard publicly owned NHS organizations. They can be publicly owned but autonomous, or independent (both in for-profit and not for profit). The paper discusses the wide range of organizational forms available, analyzing their governance structures It then discusses the small amount of evidence currently available about the performance of diverse providers of health care.

Shut Out? South East Europe and the EU's New Industrial Policy

This paper explores the potential role of industrial policy to stimulate post-crisis recovery in South East Europe (SEE). Policy reactions in the region have focused on fiscal consolidation and austerity, while the design of active industrial policies to improve competitiveness has been less in evidence. The paper reviews the experience of industrial policies in the EU and shows how these policies have evolved from vertical to horizontal approaches, and how the latter versions of policy have been transferred to the accession states in SEE. The paper reviews the evolution of industrial policies in eight countries of the region and the impact of these policies on industrial production. It argues that the horizontal industrial policies that have been imposed on SEE countries through conditionality embodied in the EU accession process have left their economies vulnerable to adverse spillovers from the eurozone crisis. It concludes with an assessment of the relevance of industrial policies to economic recovery, and questions whether SEE has been ‘shut out’ of the ‘fresh’ vertical industrial policy that has been adopted by the EU in recent years.

On the dynamic instability of induced-migration unemployment in a dual economy

Abstract Previous attempts to integrate the Todarian analysis of rural-urban migration with the dual economy growth model have relied upon an essentially static version of the migration hypothesis, inappropriate in a growth context. In this paper it is shown that when a dynamic version of the hypothesis is used the steady-state growth equilibrium, whilst characterised by a positive unemployment rate typical of Todarian models, is unstable. These results have policy implications which differ from those presented in the previous literature.

Entrepreneurship and Competitiveness: The Europeanisation of Small and Medium‐sized Enterprise Policy in Croatia

This article presents the current position of the small and medium‐sized enterprises (SME) sector in Croatia and some selected indicators of the level of entrepreneurial activity. It also evaluates different components of SME policy and performance in the context of Croatia’s progress in the European integration process. The main part of the article presents qualitative research findings based on focus group interviews with Croatian entrepreneurs. In conclusion, the main obstacles to effective policy implementation are identified and the role that the Europeanisation of policy can play in improving the process of policy implementation in this field is examined.

The Western Balkans

The break-up of Yugoslavia in 1991 following proclamations of independence by the republics of Slovenia, Croatia, Macedonia, and in 1992 of Bosnia and Herzegovina established several new states in the region. It was followed by a decade of conflict. Wars broke out in Croatia in 1991, in Bosnia and Herzegovina from 1992 to 1995, in Serbia and Kosovo 1999, and serious insurgency occurred in Macedonia in 2001. Albania, already well established as an independent state, did not escape a violent civil conflict following the collapse of a number of pyramid savings banks in 1997. The turbulence in the region calmed down following the intervention of international institutions, including armed intervention by NATO in the Kosovo conflict, and active diplomatic intervention by the EU in resolving the Macedonian conflict in 2001.