The politics of credit claiming: Rights and recognition in health policy feedback

Abstract

Why do governments recognize rights? In this article, we rely on natural experiments and an innovative matching technique to identify a new causal mechanism of policy feedback, which we refer to as the "recognition" effect. We rely on the "hard case" of health care to demonstrate that attitudes towards the health system change in response to government policy change and, indeed, even to rightsbased initiatives. During the time when public opinion surveys on public satisfaction with the health system were in the field, governments in both Germany and Sweden introduced a new right: the right to a maximum waiting time for health services. This serendipity allowed us to compare respondents' attitudes both before (control) and after the implementation of the waiting time guarantee (treatment), using coarsened exact matching to account for the imbalances in the treatment and control groups. We find that respondents interviewed after implementation of the new waiting time guarantees (in contrast to those interviewed before the introduction of the guarantees) express higher levels of satisfaction with the health system in general, but do not evaluate their specific medical treatment (including waiting times) more positively. We interpret this finding as evidence that citizens respond to governmental recognition of their rights as a good per se, independent of their personal experience with the particular public service at hand. Thus, we argue that theories of policy feedback need to move beyond their focus on direct material experience with the policies at hand, and to incorporate mechanisms of symbolic action and normative valuations into their causal models.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Political legitimacy and welfare state futures: Introduction

“…Previous studies have used political partisanship (Goerres & Tepe, ), economic individualism (Blekesaune, ; Blekesaune & Quadagno, ), and gender role attitudes (Chung & Meuleman, ) to determine why individuals will support a certain policy area or the welfare state in general. Lastly, welfare attitudes are affected by the current policy provision, both the level and the structure, as well as other socio‐economic conditions of the country (Blekesaune, ; Chung & Meuleman, ; see also the other contributions to this issue: Burlacu, Immergut, Oskarson, & Rönnerstrand, ; Cappelen, Cappelen, Kuhnle, & Tungodden, ; Kootstra & Roosma, ; Lubbers, Diehl, Kuhn, & Albrekt Larsen, ; Taylor‐Gooby, Chung, & Leruth, ; in particular, Burlacu et al, ; Lubbers et al, ). Regarding the relationship between current policy levels and support, both a positive and negative relationship have been put forward.…”

“…Burlacu et al () in their contribution to this issue consider how granting new rights in health care influences attitudes in a natural experiment. Recent reforms gave citizens' new rights to a maximum waiting time for health services in Germany and Sweden.…”

“…The contribution from Burlacu et al () aims to overcome this problem with a unique natural field experiment examining changes in healthcare provision in two different countries to see how attitudes have changed as a result. The innovative approach they apply in their article was possible due to the timing of the data collection of the two data sets used for their survey—some before and some after the implementation of a major policy reform.…”

“…Further, their article shows that such reforms and the coverage of the reforms may not necessarily influence people's attitude towards the precise element of policy, but may affect the general perception of the policy. The authors note this as a recognition effect, where “citizens respond to governmental recognition of their rights as a good per se, independent of their personal experience with the particular public service at hand” (Burlacu et al, , p. 880).…”

“…The two experiments included in this issue are unique in that both were able to carry out an experimental study using a nationally representative sample. In the case of Burlacu et al (), this was due to the natural coincidence of the timing of a large scale data collection and policy reforms. In the case of Kootstra and Roosma (), this was possible due to the scale of the project which allowed the experiment to be conducted with a longitudinal survey with a larger representative sample.…”