In many countries, public services such as health care and education are both funded by the state and provided by state monopolies. Others use a ‘quasi-market’ form of public service delivery, retaining state funding for the service, but with users having the choice of independent providers operating in a competitive market. This paper tries to clarify some of the ethical issues involved in comparing quasi-markets vs. state monopolies. It is argued that, in comparison with state monopoly, quasi-markets can promote service users’ freedom, autonomy and sense of well-being, though whether they do so in practice will depend on certain empirical conditions being fulfilled. The impact of quasi-markets on provider motivation is also discussed, arguing that the ethical judgments involved will again depend in part upon empirical considerations, including the extent of public service motivation in private and public providers.
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