Julian Le Grand

Julian Le Grand
London School of Economics and Political Science | LSE · Marshall Institute

About

370
Publications
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12,230
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Publications

Publications (370)
Article
Full-text available
Economists and others have used the results from behavioral economics to justify paternalistic government policies, aimed at changing an individual’s behavior in the present so as to improve that individual’s well-being in the future. Examples include the automatic enrollment in pension schemes and anti-smoking measures, such as banning smoking in...
Article
Economics for the Common Good, Jean Tirole. Princeton University Press, 2017, xi + 563 pages. - Volume 35 Issue 1 - Julian Le Grand
Article
Full-text available
Public service mutuals are a form of employee-led organization in which service workers spin out of the public sector to form “mutuals” that contract back with government to provide a service. This article draws on economic and psychological theory to demonstrate that mutuals can align both self-interested and altruistic or public service motivatio...
Article
Full-text available
Public service mutuals are a form of employee-led organization in which service workers spin out of the public sector to form “mutuals” that contract back with government to provide a service. This article draws on economic and psychological theory to demonstrate that mutuals can align both self-interested and altruistic or public service motivatio...
Book
The book has its origins in a course taught to first-year undergraduate social science students at the University of Sussex. Although some of them were prospective economics majors, the rest either had no background in economics or were not going on any further in the subject. The aim of the course was to introduce them to some of the distinctive f...
Chapter
This chapter examines arguments over government paternalism derived from considerations of individual well-being. It begins with a discussion of the classical economic model of rationality and the emergence of an alternative model during the twentieth century. It then reviews an increasing volume of evidence from behavioral economics and psychology...
Chapter
This chapter examines the argument that government paternalism harms or inappropriately restricts individual autonomy. More specifically, it considers the criticism that the paternalist government is actually a “nanny state”: the state is seen to treat its citizens as a nanny treats her charges, instead of as autonomous adults. After elaborating on...
Chapter
This chapter examines the so-called nudge ideas based on libertarian paternalism and asymmetric paternalism, both of which seek to provide a practical approach to the trade-off between well-being and autonomy. Nudge policies are government interventions that seek to change the context in which people make choices—the “choice architecture”—so as to...
Chapter
This chapter summarizes the book's arguments and uses them to address two central questions: whether a paternalistic government is necessarily a nanny state that infantilizes its citizens and illegitimately erodes their autonomy, or whether it could be a helpful friend that promotes their well-being without undermining autonomy. The chapter suggest...
Book
Should governments save people from themselves? Do governments have the right to influence citizens' behavior related to smoking tobacco, eating too much, not saving enough, drinking alcohol, or taking marijuana—or does this create a nanny state, leading to infantilization, demotivation, and breaches in individual autonomy? Looking at examples from...
Chapter
This chapter examines the politics of paternalism. It first considers the question of whether the government can do better than the individual, outlining a set of justifications for government paternalism and showing how the state can intervene to improve the well-being of its citizens. It then discusses possible ways in which the government could...
Chapter
This chapter examines the impact of actual paternalistic policies, some of which are already in place, on well-being and autonomy. It first describes four principal types of policy intervention that are potentially paternalistic: interventions involving legal restrictions, those involving taxation or negative financial incentives, those involving s...
Chapter
This chapter examines the prevalence of paternalistic elements in existing government policies. It first considers the range of interventions that may be viewed as involving elements of government paternalism, including the provision of information, subsidies or other forms of positive financial incentives, and the imposition of legal restrictions,...
Chapter
This chapter examines the various definitions of government paternalism and paternalistic policies that political philosophers and others have put forward, with particular emphasis on their strengths and weaknesses. It considers the three components of these definitions: there is interference in the individual's freedom or autonomy; such interferen...
Chapter
This chapter considers some of the confusions in the literature over the different terminologies used to describe various kinds of government paternalism, including legal paternalism, soft and hard paternalism, and means- and ends-related paternalism. More specifically, it discusses paternalistic interventions whose intention is to replace the indi...
Article
The government’s changes to the NHS in England come into force on 1 April. David Hunter argues that they will result in creeping privatisation and destroy the public service ethos but Julian Le Grand (doi:10.1136/bmj.f1951) thinks that more competition will improve the quality of care Will the coalition government’s changes to the health service...
Article
How can individuals best be encouraged to take more responsibility for their well-being and their environment or to behave more ethically in their business transactions? Across the world, governments are showing a growing interest in using behavioural economic research to inform the design of nudges which, some suggest, might encourage citizens to...
Article
Full-text available
This paper examines the provider side of the care-home sector and focuses on managers' and owners' motivations for providing care-home services for older people, and whether those motivations changed between 1994 and 2003. There were a number of significant policy changes over that time, including an increased ‘marketisation’ of the sector, coupled...
Chapter
This chapter considers the implications of the neuroscience of caregiving and altruism for the discipline of political science. It describes the non-biological explanations for human behavior widely used in political science and questions their validity given new knowledge about the evolution of altruism and the neurophysiology of human behavior. I...
Article
Encouraging individuals to change their behaviour towards the environment is an increasingly important area of policy-making. Julian Le Grand and Kate Disney find that the introduction of a charge for plastic bags in Marks and Spencer shops successfully encouraged pro-environmental behaviour and explore the implications for environmental policy.
Book
Le point de vue des économistes dans le débat sur la santé est réducteur. Mais tout réducteur qu'il soit, ce point de vue est aussi inévitable. En matière de santé comme ailleurs, nos sociétés ont à faire des choix que l'on qualifie habituellement d'économiques. La question de la bonne affectation des ressources entre tes différents besoins de sant...
Article
There are several models for delivering public services such as health care or education, most of which can be summarised under the headings of trust, mistrust, voice, and choice. Each contains assumptions concerning the motivation of the professionals and others who provide the service concerned: that is, the extent to which they are “knaves,” mot...
Article
There are four basic models of health service delivery: those that rely on trust, on command and control, on voice, and on choice and competition. All have their merits and demerits; but there are both theoretical and empirical arguments for preferring choice and competition in many situations. However, the relevant policies do have to be properly...
Article
This study aimed to evaluate whether subjective assessments of unmet need may complement conventional methods of measuring socioeconomic inequity in health care utilization. This study draws on the 2003 Canadian Community Health Survey to develop a conceptual framework for understanding how unmet need arises, to empirically assess the association b...
Article
Full-text available
This article reviews the social care evidence concerning direct payments/personal budgets, before arguing for an extension of these concepts to the National Health Service (NHS). Despite a commitment to inter-agency health and social care, direct payments/personal budgets have only been available for the 'social care' part of people's lives. Moreov...
Article
Full-text available
To determine whether observable changes in waiting times occurred for certain key elective procedures between 1997 and 2007 in the English National Health Service and to analyse the distribution of those changes between socioeconomic groups as an indicator of equity. Retrospective study of population-wide, patient level data using ordinary least sq...
Article
How can we ensure high-quality public services such as health care and education? Governments spend huge amounts of public money on public services such as health, education, and social care, and yet the services that are actually delivered are often low quality, inefficiently run, unresponsive to their users, and inequitable in their distribution....
Article
Sir William Beveridge in his famous report wanted to eliminate the five giants of want, squalor, idleness, ignorance and disease: the giants of too little. However, the problems facing welfare states are more the giants of too much: the giants of excess. For health in particular, excessive behaviours of various kinds contribute significantly to the...
Article
Mark Thompson deplores the decline in the public trust of government and of public service institutions such as the BBC. But there has also been a decline in another form of trust: government's trust in the ability of professionals such as doctors and teachers to deliver high quality public services. And, unlike Thompson's type of trust, this decli...
Article
Commissioning of social care for older people has seen major changes since the early 1990s. Considerable responsibility now rests with local authority staff, whose views of care home providers’ motivations, their perceived strengths and weaknesses as service providers, will have a bearing on commissioning decisions. We examine commissioners’ views...
Article
To identify factors that explain patient satisfaction with general practice physicians and hence that may drive patients' choice of practice. Logistic regression analysis of English National Health Service national patient survey data is used to identify the aspects of general practice care that are associated with high levels of overall satisfacti...
Article
The purpose of the paper is to investigate the inter- and intra-organisational relationships in the commissioning of secondary care by primary care trusts in England, using a principal-agent framework. The methodology is a qualitative study of three case studies. A total of 13 commissioning-related meetings were observed. In total, 21 managers and...
Article
In this paper, we review some of what is known about economic incentive schemes and also consider the potential role of agencies involved in policy that directly or indirectly affect health in these areas. We apply five criteria to help identify the relative strengths and weaknesses of different schemes: their effectiveness, their cost relative to...
Book
Social policy is now central to political debate in Britain. What has been achieved by efforts to improve services and reduce poverty? What is needed to deliver more effective and popular services to all and increase social justice? How can we make social policy work? These are some of the questions discussed in this book. The book covers key issue...
Book
A country's social policy reflects its values, hence identifying its ideological framework is important in determining, understanding, and anticipating a country's position on social policy. In the United Kingdom, belief in the autonomy of the individual, the need to protect and assist the vulnerable, and a focus on economic growth to provide oppor...
Chapter
As a country's social policy reflects its values, understanding and anticipating a country's position on social policy first calls for identifying its ideological framework. In the United Kingdom, belief in the autonomy of the individual, the need to protect and assist the vulnerable, and a focus on economic growth to provide opportunity for all de...
Article
Is the British National Health Service (NHS) equitable? This paper considers one part of the answer to this: the utilization of the NHS by different socioeconomic groups (SEGs). It reviews recent evidence from studies on NHS utilization as a whole based on household surveys (macro-studies) and from studies of the utilization of particular services...
Article
The politics of choice and competition in public services are complex. Only public service users seem basically to want choice. Providers prefer alternative models of service delivery especially those that rely upon trust. Social democrats prefer voice and trust; conservatives want choice and competition to be exercised in the context of a full pri...
Article
This article examines collaborations between primary care trusts in the commissioning of secondary care services in England. It applies principal-agent theory qualitatively to two case studies. The theory suggests that collaboration should take place if organizations share relevant information and agree joint objectives. The study findings show tha...
Article
How can we ensure high-quality public services such as health care and education? Governments spend huge amounts of public money on public services such as health, education, and social care, and yet the services that are actually delivered are often low quality, inefficiently run, unresponsive to their users, and inequitable in their distribution....
Article
Full-text available
In October 2003, I started a secondment from the London School of Economics (LSE), where I hold the Richard Titmuss Chair of Social Policy, to No 10 Downing Street, where I worked as a senior policy adviser to the Prime Minister, Tony Blair. I began working initially on a specific project: developing policies on extending user choice in public serv...
Article
Full-text available
There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they...
Article
Full-text available
The shift in the balance of health care, bringing services 'closer to home', is a well-established trend. This study sought to provide insight into the consequences of this trend, in particular the stimulation of demand, by exploring the underlying feedback structure. We constructed a simulation model using the system dynamics method, which is spec...
Article
Full-text available
Mathias Risse has provided a thoughtful critique of my book, raising serious points about a major part of the argument. I am glad to have the opportunity to reflect further on it.
Article
This paper explores the motivation and behaviour of hospitals, using data from UK hospital Trusts. Managers and consultants (hospital specialists) are identified as the main alternative sources of power within Trusts. It is hypothesised that consultants are interested in production or service (volume and quality) while managers are interested prima...
Article
Full-text available
Why is social exclusion a problem? What about ‘voluntary’ social exclusion – when an individual chooses to exclude him or herself from the wider society? Brain Barry has addressed these questions in a recent CASE book, arguing that social exclusion, voluntary or involuntary, offends against social justice and social solidarity. This paper contends...
Article
Can we rely on the public service ethos to deliver high quality public services? Are professionals such as doctors and teachers really public‐spirited altruists—knights—or self‐interested egoists—knaves? And how should the recipients of those services, patients, parents, and pupils, be treated? As passive recipients—pawns—or as active consumers—que...

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