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The Demand and Supply of Parliamentary Policy Advocacy: Evidence from UK Health Policy, 1997–2005
Published online by Cambridge University Press: 02 January 2013
Abstract
Fundamental to democratic politics is the quality of representation of constituents' interests by elected officials. This article statistically examines a case of substantive policy advocacy in Great Britain: the issues of wait times and health rationing by the National Health Service (NHS), salient throughout the Blair years. An increase in constituent need for care implies an increase in demand for parliamentary representation, yet representation will not necessarily be supplied, because legislators juggle conflicting interests. We measure representative action using parliamentary questions from 1997–2005. Party and parliamentary status and a set of indicators of the health of British citizens provide measures of political supply and constituent demand. Employing count-regression techniques, we find increased parliamentary questions as the proportion of individuals with some high health risks rises, but opposite results for other health risks. Evidence of political supply is much more consistent, suggesting that political careerism goes a long way towards explaining whether MPs table any questions at all in this policy area.
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References
2 Pitkin, Hanna Fenichel, The Concept of Representation, Berkeley, University of California Press, [1967] 1972.Google Scholar
3 Fenno, Richard, Home Style: House Members in their Districts, Boston, Little, Brown, 1978 Google Scholar; Norton, Philip and Wood, David M., Back from Westminster: British Members of Parliament and their Constituents, Lexington, University Press of Kentucky, 1993.Google Scholar
4 Stokes, Donald E. and Miller, Warren E., ‘Constituency Influence in Congress’, American Political Science Review, 57: 1 (1963), pp. 45–56.Google Scholar
5 Norton and Wood, Back from Westminster.Google Scholar
6 Ibid.Google Scholar
7 Poole, Keith T. and Rosenthal, Howard, Congress: A Political-Economic History of Roll-call Voting, New York, Cambridge University Press, 1997.Google Scholar
8 Judge, David, Representation: Theory and Practice in Britain, London, Routledge, 1999.Google Scholar
9 Pattie, Charles, Fieldhouse, Edward and Johnston, R. J., ‘The Price of Conscience: The Electoral Correlates and Consequences of Free Votes and Rebellions in the British House of Commons, 1987–92’, British Journal of Political Science, 24: 3 (1994), pp. 359–80.CrossRefGoogle Scholar
10 Diana Woodhouse, Ministers and Parliament: Accountability in Theory and Practice, Oxford, Oxford University Press, 1994.Google Scholar
11 Saalfeld, Thomas, ‘Members of Parliament and Governments in Western Europe: Agency Relations and Problems of Oversight’, European Journal of Political Research, 37: 3 (2000), pp. 353–76.CrossRefGoogle Scholar
12 Pitkin, The Concept of Representation.Google Scholar
13 Stimson, James A., MacKuen, Michael B. and Erickson, Robert S., ‘Dynamic Representation’, American Political Science Review, 89: 3 (1995), pp. 543–65.CrossRefGoogle Scholar
14 Pattie, Fieldhouse and Johnston, ‘The Price of Conscience’.Google Scholar
15 Norton and Wood, Back from Westminster. Google Scholar
16 Pattie, Fieldhouse and Johnston, ‘The Price of Conscience’.Google Scholar
17 Gaines, Brian J., ‘The Impersonal Vote? Constituency Service and Incumbency Advantage in British Elections, 1950–92’, Legislative Studies Quarterly, 23: 2 (1998), pp. 167–95.CrossRefGoogle Scholar
18 Saalfeld, ‘Members of Parliament and Governments in Western Europe’.Google Scholar
19 Norton, and Wood, Back from Westminster.Google Scholar
20 Ibid.; Cain, Bruce E., Ferejohn, John A. and Fiorina, Morris P., ‘The House is Not a Home: British MPs in Their Constituencies’, Legislative Studies Quarterly, 4: 4 (1979), pp. 501–23;CrossRefGoogle Scholar Gaines, ‘The Impersonal Vote?’.
21 Norton and Wood, Back from Westminster.Google Scholar
22 Fenno, Home Style.Google Scholar
23 Norton and Wood, Back from Westminster.Google Scholar
24 Ibid.; Fenno, Home Style.Google Scholar
25 Norton, Philip and Wood, David M., ‘Constituency Service by Members of Parliament: Does it Contribute to a Personal Vote?’, Parliamentary Affairs, 43 (1990), pp. 196–208.CrossRefGoogle Scholar
26 Ibid.Google Scholar
27 Norton, Philip, ‘Dissent in the British House of Commons: Rejoinder to Franklin, Baxter, Jordan’, Legislative Studies Quarterly, 12: 1 (1987), pp. 143–52.CrossRefGoogle Scholar
28 Cole, Michael, ‘Accountability and Quasi-Government: The Role of Parliamentary Questions’, Journal of Legislative Studies, 5: 1 (1999), pp. 77–101.CrossRefGoogle Scholar
29 Matti Wiberg, ‘Parliamentary Questioning: Control by Communication?’, in H. Döring (ed.), Parliaments and Majority Rule in Western Europe, New York, St Martin's Press, 1995, pp. 179–222. The reasons are: ‘To request information[;] To press for action[;] To gain personal publicity[;] To demand an explanation[;] To test ministers in controversial areas of their policies[;] To attack ministers in difficult political situations[;] To dispose of a large number of heterogeneous topics rapidly and conveniently[;] To show concern for the interests of constituents[;] To help build up a reputation in some particular matters[;] To force compromises on an unwilling government[;] To delay a headstrong government until other forces and events make their influence felt[;] To demonstrate the government's faults[;] To rally the troops within an opposition party, with only a remote intention of forcing change on the government[;] To create elements of drama’ (p. 181).Google Scholar
30 Norton and Wood, Back from Westminster.Google Scholar
31 Wiberg, ‘Parliamentary Questioning’.Google Scholar
32 Norheim, Ole Frithjof, ‘Healthcare Rationing – Are Additional Criteria Needed for Assessing Evidence Based Clinical Practice Guidelines?’, British Medical Journal, 319: 7222 (1999), pp. 1426–9.CrossRefGoogle ScholarPubMed
33 Ham, Chris, ‘Tragic Choices in Health Care: Lessons from the Child B Case’, British Medical Journal, 319: 7219 (1999), pp. 1258–61.CrossRefGoogle ScholarPubMed
34 National Institute for Clinical Excellence. ‘A Guide to NICE’ 2005, available at www.nice.org.uk/guidetonice (accessed 15 February 2007).Google Scholar
35 Ham, Chris, ‘Population-Centered and Patient-Focused Purchasing: The U.K. Experience’, Milbank Quarterly, 74: 2 (1996), pp. 194–214.CrossRefGoogle ScholarPubMed
36 Bevan, Gwyn and Robinson, Ray, ‘The Interplay between Economic and Political Logics: Path Dependency in Health Care in England’, Journal of Health Politics, Policy and Law, 30: 1–2 (2005), pp. 54–77.CrossRefGoogle ScholarPubMed
37 Wailoo, Allan, Roberts, Jennifer, Brazier, John and McCabe, Chris, ‘Efficiency, Equity, and NICE Clinical Guidelines’, British Medical Journal, 328: 7439 (2004), pp. 536–7.CrossRefGoogle ScholarPubMed
38 Norheim, ‘Healthcare Rationing’.Google Scholar
39 Eddy, D. M., ‘Clinical Decision Making: From Theory to Practice. Guidelines for Policy Statements: The Explicit Approach’, Journal of the American Medical Association, 263: 16 (1990), pp. 2239–40, 2243.CrossRefGoogle ScholarPubMed
40 O'Boyle, Ciaran P. and Coyle, Richard P., ‘Rationing in the NHS: Audit of Outcome and Acceptance of Restriction Criteria for Minor Operations’, British Medical Journal, 323: 7310 (2001), pp. 428–9.CrossRefGoogle ScholarPubMed
41 Martin, Stephen and Smith, Peter C., ‘Rationing by Waiting Lists: An Empirical Investigation’, Journal of Public Economics, 71: 1 (1999), pp. 141–64.CrossRefGoogle Scholar
42 Goddard, J. A. and Tavakoli, M., ‘Referral Rates and Waiting Lists: Some Empirical Evidence’, Health Economics, 7: 6 (1998), pp. 545–9.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
43 Lindsay, Cotton and Feigenbaum, Bernard, ‘Rationing by Waiting Lists’, American Economic Review, 74: 3 (1998), pp. 404–17;Google ScholarPubMed
44 Timmins, Nicholas, ‘Use of Private Health Care in the NHS’, British Medical Journal, 331: 7525 (2005), pp. 1141–2.CrossRefGoogle ScholarPubMed
45 Warden, John, ‘NHS is Commons Combat Zone’, British Medical Journal, 316: 7146 (1998), p. 1694.CrossRefGoogle Scholar
46 Erin Penner, Kelly Blidook and Stuart Soroka, ‘Legislative priorities and public opinion: representation of partisan agendas in the Canadian House of Commons,’ Journal of European Public Policy, 13: 7 (2006), pp. 1006–20 employ a similar technique for statistically analysing questions in the Canadian Parliament. However, they use a proportion of ‘column centimetres’, i.e. the amount of space given on each topic as a proportion of all column centimetres to ascertain relative attention across a number of issues. Our use of numbers of questions does not seem biased in this case, as the overwhelming majority of the questions in our dataset are rather brief and we are not interested in cross-topic comparisons.Google Scholar
47 The ‘Question Book’ is available at http://www.publications.parliament.uk/.Google Scholar
48 Our measures of constituency health characteristics are based on census data and do not vary over time. We pool all mentions because of this and employ the count regression model described below to take full advantage of the structure of the data available. To respect the simplifications inherent in such pooling, we measure political variables such as frontbench service with a temporal dimension, rather than simply as indicator variables.Google Scholar
49 CACI Inc., ‘HealthACORN User Guide’, 2006, available at http://www.caci.co.uk/pdfs/healthacornuserguide.pdf (accessed 29 March 2007).Google Scholar
50 The system is available at http://geoconvert.mimas.ac.uk.Google Scholar
51 Crepon, Bruno and Duguet, Emmanuel, ‘Research and Development, Competition and Innovation Pseudo-Maximum Likelihood and Simulated Maximum Likelihood Methods Applied to Count Data Models with Heterogeneity’, Journal of Econometrics, 79: 2 (1997), pp. 355–78.CrossRefGoogle Scholar
52 This is an improvement over the Poisson regression model in cases, such as ours, where the mean of the count variable (μwait times = 0.43, μrationing = 0.48) is not equal to its variance (σ2 wait times = 1.15, σ2 rationing = 2.56).Google Scholar
53 White, Halbert, ‘Maximum Likelihood Estimation of Misspecified Models’, Econometrica, 50: 1 (1982), pp. 1–24.CrossRefGoogle Scholar
54 Wooldridge, Jeffrey M., ‘Cluster-Sample Methods in Applied Econometrics’, American Economic Review (Papers and Proceedings), 93: 2 (2003), pp. 133–8.CrossRefGoogle Scholar
55 Variance inflation factors for the models range from 1 to 3.74 with a mean of 2.Google Scholar
56 Vuong, Quang H., ‘Likelihood Ratio Tests for Model Selection and Non-Nested Hypotheses’, Econometrica, 57 (1989), pp. 307–34.CrossRefGoogle Scholar
57 Primary care trusts (PCTs) in both the most rural and least deprived fifths of all PCTs were most likely to run a deficit (68 per cent). By contrast, only 3 per cent of PCTs in the least rural and most deprived fifth ran deficits ( Asthana, Sheena and Gibson, Alex, ‘Rationing in Response to NHS Deficits: Rural Patients are Likely to be Affected Most’, British Medical Journal, 331: 7530 (2005), p. 1472).CrossRefGoogle ScholarPubMed
58 Ibid.Google Scholar
59 Norton and Wood, Back from Westminster; Gaines, ‘The Impersonal Vote?’.Google Scholar
60 Norton and Wood, Back from Westminster.Google Scholar
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