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 rights-based 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.