Alain Enthoven

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Alain C. Enthoven (born September 10 1930)[1] was Deputy Assistant Secretary of Defense from 1961 to 1965. From 1965 to 1969 he was Assistant Secretary of Defense for Systems Analysis. He is Marriner S. Eccles Professor of Public and Private Management, Emeritus, at Stanford Institute for International Studies. he has been credited with developing the ideas the have led to the creation of 'market-like' structures within the public sector, particularly in the UK.

Enthoven features in the recent BBC TV series The Trap.

At Rand

Kill targets in Vietnam

Introducing the Market to the NHS

Enthoven was a key figure in the introduction of the internal market to the NHS in the UK. This was accomplished under the Conservatives in the 1980s and then built on by New Labour - though they claimed to have abolished the internal market. Enthoven seems first to have come to the UK as part of this work in 1984 when he was a Fellow funded by the Nuffield Provincial Hospitals Trust, London.

Later Enthoven reportedly described New Labour's reforms as 'a logical extension' or his own plans. Enthoven said that instead of the "comparatively timid Thatcher-Enthoven" model, Milburn was describing "a bold wide-open market". He added: "Whether he means it or not, and whether he can or will deliver it, it is a logical extension of the internal market ideas."[2]

Professor Enthoven told The Times: "I find it really rather irksome when I hear the Labour Party saying it abolished the internal market because it did not work, all of which is not true. It was a Thatcherite proposal to create the trust hospitals and the fundholders, which have now become the basis for the primary care trusts. You could say, 'Look, Mr Milburn, what is different?'" "If the Thatcher Government did not go further it was because they were vilified for doing what they did. The attacks were extremely vicious and Labour said they would abolish it, but they have done no such thing. They have built on it."[3]


Enthoven received his B.A. from Stanford University in 1952, an M.Phil. from the University of Oxford in 1954, and a Ph.D. from MIT in 1956. He was a RAND Corporation economist between 1956 and 1960.

Deputy Comptroller/Deputy Assistant Secretary 1961-1965
Assistant Secretary of Defense for Systems Analysis 1965-1969
Vice President, Economic Planning 1969-1971
President, Litton Medical Products 1971-1973
  • 1973-2000: Stanford University Professor
  • 1998-9 Visiting Professor, London School of Hygiene and Tropical Medicine and Rock Carling Fellow, Nuffield Trust (London)

Honors and Awards

President's Award for Distinguished Federal Civilian Service, presented by President Kennedy in 1963.

Department of Defense Medal for Distinguished Public Service, awarded by Secretary Clifford in January 1969.

Rhodes Scholarship

Fellow of the American Academy of Arts and Sciences

The 1994 Baxter Prize for Health Services Research

The 1994 Clifton J. Latiolais Honor Medal, American Managed Care Pharmacy Association

The 1995 Board of Directors Award, Healthcare Financial Management Association

The 1998 Paul Ellwood Award for Efforts in Health Care Accountability, Foundation For Accountability

The Rock Carling Fellow, Nuffield Trust, London 1998-99.


He is a member of the Institute of Medicine, a fellow of the American Academy of Arts and Sciences, and is a former Rhodes scholar.

Other Positions

Instructor in Economics, Massachusetts Institute of Technolgy, 1955-56; Consultant, Brookings Institution, 1956-60; Visiting Associate Professor of Economics, University of Washington, 1958; Board of Directors, Georgetown University (Medical Center Committee), 1968-73; Stanford University Computer Science Advisory Committee, 1968-73; Consultant RAND Corporation, 1969-; Massachusetts Institute of Technology, Visiting Committee in Economics, 1971-78; Board of Regents St. John's Hospital, Santa Monica, 1971-73; California Institute of Technology, Visiting Committee on Environmental Quality Laboratory, 1972-75; Consultant, Kaiser Foundation Health Plan, 1973-; Member of the Institute of Medicine of the National Academy of Sciences, 1972-, Council 1975-77; Visiting Committee, Harvard School of Public Health, 1974-80; Visiting Committee, University Health Services, Harvard University, 1980-86; Special Consultant to Secretary of DHEW on National Health Insurance, 1977-78; Visiting Committee, Whitaker College, Massachusetts Institute of Technology, 1981-1985; Research Advisory Board, Palo Alto Medical Foundation, 1982-87; Extramural Advisory Group, Health Care Studies Unit, Mayo Clinic, 1982. Visiting Professor, University of Rennes, 1983; Fellow, Nuffield Provincial Hospitals Trust, London, 1984; Visiting Professor, University of Paris, 1985; Christensen Visiting Fellow, St.Catherine's College, Oxford, 1985; Board of Directors, Hotel Investors, Inc., 1986-1987; Board of Directors, PCS, Inc., 1986-1989. Former chairman, Committee on Faculty/Staff Benefits, Stanford University, 1986-1992; Health Benefits Advisory Council, Public Employees Retirement System, State of California, 1989-1991, Chairman, 1991- 1995; Board of Directors, The Jackson Hole Group, 1994-1996; Caresoft, Inc., 1996-2002; eBenX 2000-2003. Visiting Committee, The Kennedy School of Government, Harvard University, 1996 –2003; Chairman, California Managed Health Care Improvement Task Force, 1997-98; Board of Directors, The Integrated Health Care Association, 1999—present. Research Advisory Board, Committee for Economic Development, 2000-2003. Board of Directors, RxIntelligence, 2000-2003.

Selected Publications

  • How Much is Enough? Shaping the Defense Program 1961-1969 (with K. Wayne Smith). Harper & Row, New York, 1971. Reprinted, Kraus Reprint, Millwood, New York, 1980.
  • Pollution, Resources and the Environment, a book of readings in Problems of the Modern Economy, edited with A. Myrick Freeman III, W.W. Norton, New York, 1973.


  • Introduction to A Modern Design for Defense Decision, A McNamara-Hitch-Enthoven Anthology, edited by S.A. Tucker, Industrial College of the Armed Forces, Washington, D.C., 1966.
  • "A Neo-Classical Model of Money, Debt, and Economic Growth," In J.G. Gurley and E.S. Shaw, Money in a Theory of Finance, The Brookings Institution, Washington, D.C., 1960.
  • "Monetary Disequilibria and the Dynamics of Inflation." The Economic Journal, LXVI: 264, June 1956.
  • "A Theorem on Expectations and the Stability of Equilibrium" (with Kenneth J. Arrow). Econometrica, 24:3, July 1956.
  • "Quasi-Concave Programming" (with Kenneth J. Arrow). Econometrica, 29:4, October 1961.
  • "Reason, Morality, and Defense Policy." America, 108: 14 and 15, April 1963.
  • "What Forces for NATO? and from Whom?" (with K Wayne Smith). Foreign Affairs, 48:1, October 1969.


  • "The Planning, Programming, and Budgeting System in the Department of Defense: An Overview from Experience" (with K. Wayne Smith). In Public Expenditures and Policy Analysis, Robert Haveman and Julius Margolis eds., Chicago, Markham, 1970.
  • "U.S. Forces in Europe: How Many? Doing What?" Foreign Affairs, 53:3 April 1975.
  • “Consumer Choice Health Plan: A National Health Insurance Proposal Based on Regulated Competition in the Private Sector,” (in two parts) New England Journal of Medicine 298 (12 and 13) March 23 and 30, 1978.
  • "Cutting Cost Without Cutting the Quality of Care." Shattuck lecture before the Annual Meeting of the Massachusetts Medical Society, Boston, May 24, 1978; published in The New England Journal of Medicine, June 1, 1978.
  • "Consumer-Centered vs. Job-Centered Health Insurance." In Harvard Business Review, 57:1, January-February 1979.


  • Health Plan:The Only Practical Solution to the Soaring Cost of Medical Care, Addison-Wesley, May 1980.
  • Reflections on Improving Efficiency in the National Health Service: An American Looks at Health Services Organization and Management in the U.K. Occasional Paper, the Nuffied Provincial Hospitals Trust, London 1985. [4]
  • "Theory and Practice of Managed Competition in Health Care Finance. The 1987 Professor Dr. F. de Vries Lectures, North Holland Publishing Company, Amsterdam, New York 1988.
  • "A Consumer-Choice Health Plan for the 1990s: Universal Health Insurance in a System Designed to Promote Quality and Economy (in two parts)" (with Richard Kronick). New England Journal of Medicine 320 (1 and 2); 29-37 and 94-101 (January 5 and 12) 1989.


  • "Universal Health Insurance Through Incentives Reform." With Richard Kronick. Journal of the American Medical Association, Vol. 265(19) pp.2532-2536, May 1991.
  • "Internal Market Reform of the British NHS," Health Affairs 10(3)pp.60-70, Fall 1991.
  • "Quality Management in the NHS: The Physician's Role." with D.M. Berwick and J.P. Bunker. British Medical Journal, (I) Jan. 12 1992, pp.235-239; (II) Feb. 1, 1992, pp.304-308.
  • "The History and Principles of Managed Competition: Health Affairs, Vol. 12, Supplement 1993, pp.24-48. Reprinted in Readings on Public Policy (Ed. Pogodzinski, J.M.) Health Care Issues - Part I, pp. 3-25, Blackwell Publishers, Inc. Cambridge, MA, 1995.
  • "Why Managed Care Has Failed to Contain Health Costs." Health Affairs, Fall 1993, pp. 27- 43.
  • "Managed Competition and California's Health Care Economy," with Sara J. Singer Health Affairs, Vol. 15, No. 1 (Spring 1996), pp. 39-57.
  • In Pursuit of an Improving National Health Service, The Nuffield Trust (Rock Carling Fellowship), London 1999


  • Toward a 21st Century Health System: The Contributions and Promise of Prepaid Group Practice, edited with Laura Tollen, Jossey Bass, San Francisco, March 2004[5]


  1. Curriculum Vitae: Alain C. Enthoven June 2004, Stanford University
  2. The Times (London) May 7, 2002, Tuesday Milburn 'takes NHS beyond Thatcherism' BYLINE: David Charter, Chief Political Correspondent SECTION: Home news
  3. The Times (London) May 7, 2002, Tuesday Milburn 'takes NHS beyond Thatcherism' BYLINE: David Charter, Chief Political Correspondent SECTION: Home news
  4. Excerpts in 'Some reforms that might be politically feasible', The Economist, June 22, 1985, SECTION: ;Pg. 19 (U.S. Edition Pg. 19)
  5. Alain Enthoven's Curriculm Vitae, accessed 10 April 2008