Managers are assumed to act as if they had quasi-altruistic preferences. They
like income and dislike effort, but also are concerned about the net benefits produced by their health authority and about the costs of administering it. They are
similar to the quasi-altruistic providers and hospital managers of other health
service models Ellis, 1998; Halonen and Propper, 1999 and contrast with the Ž .
selfish bureaucrats of classical bureaucracy models Niskanen, 1971; Wintrobe Ž
1997 . Quasi altruism may arise because the health service attracts managers with .
such preferences. Alternatively it may be due to managers’ more selfish concerns
about career prospects or professional reputation for good management. Whilst
managers do not compete directly with each other, the large number of authorities
operating in similar circumstances provides a benchmark against which they can
be judged. Managers may therefore feel that they will be judged in part on their
ability to Arun a tight shipB