The New Institutional Economics

Current English policy towards general practice is ambivalent between developing new forms of contractual governance and constructing more hierarchically organized bodies. NHS policy documents say that Primary Care Trusts (PCTs) will contract some primary care services and directly manage others. Depending on the balance, PCTs could either organize general practice through practice-based contracts or start developing into hierarchies (albeit with some subcontractors for the time being).

New Institutional Economics, in particular Williamson's version, defines conditions where hierarchies are likely to be more efficient than markets (in terms of what welfare economics recognizes as allocative efficiency) and conditions where the reverse holds. This article considers the implications of the New Institutional Economics (NIE) for redesigning the governance of publicly financed services such as general practice which allow direct public access, in which it is difficult to define and manage service quality, and which have a professionalized but fragmented workforce. In contrast to their alleged implications for the hospital sector during the 1990s, NIE theories imply that for publicly funded professional services such as general practice there are stronger economic arguments for constructing hierarchies than for reconstructing quasi-markets at local level.