How Culture Affects Street-Level Bureaucrats’ Bending the Rules in the Context of Informal Payments for Health Care: The Israeli Case

Abstract

What is the role of culture in street-level bureaucrats' bending the rules and accepting informal payments for health care? The literature on street-level bureaucrats stresses the importance of both individual and organizational factors in understanding how they use their discretion but usually neglects the importance of the culture in determining how far they are willing to go in exercising this discretion. Using data from 102 in-depth interviews with doctors and nurses in Israel, and by linking the literature about street-level bureaucrats to that of the research on informal payments for health care, we demonstrate that the culture plays a key role in decisions about accepting such payments. According to our findings, such payments are a phenomenon rooted in the culture and range from the extreme case of bribery to the fuzzier area of making exceptions for favored and sympathetic clients. Keywords street-level bureaucracy, rules bending, informal payments for health care, culture 665919A RPXXX10.

Playing defence: the impact of trust on the coping mechanisms of street-level bureaucrats

“…What role do organizational conditions play in this dynamic? As the literature already explains, together with personal characteristics and the environment, organizational conditions are critical in understanding SLBs' discretion when deciding how to treat their clients (Cohen 2018;Cohen and Hertz 2020). In accordance with Brodkin's (2011) claim that SLBs' personal preferences are mediated by organizational conditions, we argue that to better understand the phenomenon, these organizational conditions must be evaluated.…”

“…The literature shows that the organizational conditions under which SLBs operate have a significant impact on the delivery of services (Lavee, Cohen and Nouman 2018;Cohen 2018), their performance (Destler 2017), their willingness to implement policy (Tummers et al 2012), and their choice of coping strategies when implementing policies (Cohen and Gershgoren 2016). Therefore, when we analyse the link between trust in clients and SLBs' choices in how to handle them, we must also consider the organizational conditions under which they operate.…”

Reinforcing public responsibility? Influences and practices in street‐level bureaucrats' engagement in policy design

“…With regard to organizational characteristics, the literature mentions management requirements (for example, in the context of new managerialism), organizational constraints (May and Winter 2007;Brodkin 2011), level of discretion (Hill and Hupe 2008) and influence on organizational implementation (Tummers et al 2012). Other organizational characteristics are social networks, interactions with peers (Sandfort 2000) and what their peers think and believe (Keiser 2010), subjective norms of managers (Tummers et al 2012), organizational resources and incentives (Brodkin 1997) and organizational culture (Cohen 2018).…”

Street‐Level Bureaucrats’ Social Value OrientationOn and OffDuty

“…Riccucci () underscored the role of attitudes and emotions toward clients. Other scholars pointed to street‐level bureaucrats’ ideology, attitudes, personal opinions, preferences, and values (Brodkin ; Keiser ; Maynard‐Moody and Musheno ; Meyers et al ; Wood and Vedlitz ), as well as the political and general culture (Cohen ).…”