Do We Really Want to Know? The Potentially Negative Effect of Transparency in Decision Making on Perceived Legitimacy

Abstract

Building on the notion of transparency as a strong democratic value and theories of procedural justice, this article reports an explorative experimental test whether transparency in decision making may lead to increased perceived legitimacy in terms of decision acceptance and trust. This is done in a context of difficult decisions of high importance for citizens – namely priority setting in public health care. An experiment was designed in which ordinary citizens were presented with a description of a case of priority setting between two groups with different health care needs. One group was given no information at all on the decision‐making procedure, as an example of non‐transparent decision making, and six groups were presented with different descriptions of the decision‐making procedure, as examples of transparency in decision making. The transparent procedures were derived from three basic forms of democratic decision making: representation, direct participation and expert decision making. A second manipulation framed the decision‐making procedure alternatively in positive or negative terms in order to capture media framing effects as well. According to the findings of the study, transparent decision‐making procedures tend to weaken rather than strengthen general trust in health care – a finding that might reveal obstacles to attempts to strengthen the legitimacy of health care by employing transparent procedures. The results also show that while the form of decision making had no significant impact on perceived legitimacy, positive or negative framing of a decision‐making procedure influences public perceptions of both the procedure and the decision outcome.

Legitimacy of Taiwan’s trade negotiations with China

“…14 Procedural legitimacy thus lies at the heart of the transparency and accountability of the decision-making process that warrants democratic representation and effective participation. 15 Such legitimacy is vital to cross-straits negotiations, which inevitably concern issues of constitutionality and sovereignty.…”

Decide and Defend: Regaining Authority for Controversial Decisions Through Rendering Account

“…Greater transparency may also have caused further politicisation because it does not necessarily increase citizens' trust in local government (De Fine Licht, 2011;Grimmelikhuijsen, 2012 Daniels & Sabin, 2008) because it involves the construction of a narrative through which the location decision is justified (Black, 2008, pp. 151-152).…”

Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare

“…Way back at 1997, Mechanic, instead advocated a cautious line in which the majority of difficult priority-setting decisions should be made implicit, without public awareness and debate, by ʿmuddling through elegantlyʾ. Some empirical studies, of which one experimental study was performed in Sweden, have shown that increased transparency may actually make people (at least to a point) less trusting than if less or no transparency exists (de Fine Licht, 2011). Hypothetically, it could mean that being aware of the necessity to pit the need for healthcare of some groups against the need for healthcare of other groups (based on severity level or other kinds of criteria), could make the public even more hesitant to accept politicians as decision makers.…”

“…In Sweden there are just a handful of studies that address citizens´ view on priority setting and/or rationing in resource allocation situations at the meso level (de Fine Licht, 2011, 2014aFredriksson et al, 2018;Mossialos & King, 1999;Rosén & Karlberg, 2002;Werntoft, Hallberg & Edberg, 2007;Werntoft, Hallberg, Elmståhl & Edberg, 2006;Werntoft, Hallberg, Elmståhl & Edberg, 2005;Wiss, Levin, Andersson & Tinghög, 2017). Three of these studies focused on patient level, but with one or two questions about priority setting at meso level.…”

“…or on the interactions and discussions between citizens, e.g. in focus groups (Coast, 2001;Coast, Donovan, Litva, Eyles, Morgan, Shepherd & Tacchi, 2002;de Fine Licht, 2011;Diederich, Winkelhage & Wirsik, 2011;Fredriksson, Eriksson & Tritter, 2018;Litva et al, 2002;Richardson, Charry & HammerLloyd, 1992;Rogge & Kittel, 2016;Werntoft, Edberg, Rooke, Hermeren, Elmstahl & Hallberg, 2005;Winkelhage & Diederich, 2012;Wiseman, Mooney, Berry & Tang, 2003).…”