Winds of Change: from public toprivate, from collective to

individual.

Aaron ReevesInternational Inequalities Institute

London School of Economics and Political ScienceEmail: a.reeves@lse.ac.ukTwitter: @aaronsreeves

November 2, 2017

‘WHERE BETTER TARGETINGCAN BE ACHIEVED, OR FROMWHICH THE PUBLIC SECTORCAN WITHDRAW ALTOGETHER’

Shifting away from the public sector

-10 -5 0 5 10 15 20

Percentage point change in public health spendingas proportion of all health spending

NetherlandsChile

SwitzerlandLatvia

GermanyUnited States

NorwayFinland

BelgiumItaly

IcelandLuxembourg

DenmarkAustriaPolandCanadaFrance

United KingdomSpain

EstoniaSloveniaHungarySweden

IsraelGreece

PortugalCzech Republic

IrelandSlovak Republic

Source: OECD

Financing, provision, and decision

0

10

20

30

40

50

Prop

ortio

n of

all

expe

nditu

re (%

)

1979 1995 2007

Pure Public Mixed PublicMixed Private Pure Private

Source: Hills, J. 2011. "The Changing Architecture of the UK Welfare State." Oxford Review of Economic Policy 27(4).

POLICY DRIFT

Policy drift

‘Shifting social context’ and ‘changing risks’

‘Deliberate efforts by political actors to prevent therecalibration of social programs’

Hacker J., 2004, Privatizing Risk without Privatizing the Welfare State: The Hidden Politics of Social Policy Retrenchmentin the United States, American Political Science Review.

Policy drift and the minimum wage

USA

Belgium

5000

10000

15000

20000

25000

1975 1980 1985 1990 1995 2000 2005 2010 2015

Year

Nat

iona

l min

imum

wag

e(A

djus

ted

for

infl

atio

n, P

PP,

201

4 U

SD

)

Source: OECD

Policy drift and the UK NHS

Largest ever

sustained reduction

in NHS spending

as a % of GDP

0

1

2

3

4

5

6

7

8

9

1980 1985 1990 1995 2000 2005 2010 2015 2020

Year

Exp

endi

ture

on

UK

Nat

iona

l Hea

lth

Ser

vice

(% o

f G

DP

)

OUT-SOURCING