Standing in Line when Queues are on Decline. Policy Proximity and Evaluations of Health Care Services Following the Swedish Waiting Time Guarantee Policies

Policy feedback theory suggests that policy change directly shape citizen’s attitudes and evaluations. However, an important theoretical specification is that citizen’s degree of policy proximity moderates the effect of policy change on attitudes and evaluations (Soss & Schram 2007). The current paper looks closer at the Swedish health care waiting time guarantee, which was brought into place by two consecutive programs in 2005 and 2010 and which both resulted in substantial decrease in health care waiting times. The objective is to investigate the link between policy change and public evaluations of health care services in different strata of the population, in the Västra Götaland regions, Sweden. Hypothetically, feedback effects on public opinion are expected especially among groups with high degree of policy proximity. The study is designed as a natural experiment in which attitudes towards health care services are measured before and after the reforms in 2005 and 2010. To measure public evaluations of health care services, a truly unique set of dependent variables are used from the Väst SOM survey 1998-2015, including: 1) confidence in health care personnel, 2) confidence in politicians responsible for health care, 3) assessment of the service provided at health centre 4) and at hospital, 5) assessment of health care accessibility, 6) and assessment of the effectiveness of health care as organization. To disentangle the role of policy proximity, the analysis make the important distinction between those who have 1) personal health care experience, 2) experience via close relatives, and respondents with no health care experience last twelve months. In addition, the analysis differentiates between those who are 1) in good health, and 2) in poor health, respectively.