Comparative lobbying strategies in influencing health care policy

Abstract: This paper explores the proposition that the lobbying behaviour of pressure groups is strongly influenced by whether they are output-oriented or process-oriented. We argue that where a group focuses its lobbying efforts on obtaining economic gains for its members, a more confrontational approach will be used. If an interest group does not bargain directly with government for economic gains, but rather tries to foster a positive political climate, it will practice the art of quiet diplomacy. We analyse the behaviour of the medical and hospital associations in British Columbia as interest groups and seek to identify the determinants of their different lobbying strategies, styles and techniques. We also try to assess the impact of these lobbying styles and strategies on the public policies that the groups have sought to influence, recognizing that government is also trying to influence the group's behaviour. We conclude that there are six crucial factors, some exogenous and some endogenous, that strongly influence the lobbying behaviour of health case organizations. These are the nature of the groups' membership, the focus of their lobbying activities, the cycle of group-government interaction, the length of experience with government as the principal paymaster, the presence or absence of factions within the group, and the values and attitudes of various members stemming from their socialization. Sommaire: Ce document analyse l'idée selon laquelle le comportement d'un groupe de pression est fortement influence par l'orientation de ce groupe et varie selon qu'il s'intéresse davantage aux résultats ou aux processus. Nous montrons ici qu'un groupe de pression qui s'efforce d'obtenir des gains économiques pour ses membres a tendance à adopter une attitude de confrontation. Par contre, un groupe qui ne négocie pas directement avec le gouvernement en vue d'obtenir des gains économiques, mais qui essaie plutôt d‘établir un climat politique favorable, a tendance à agir avec “diplomatie”. Nous analysons le comportement des associations médicales et hospitalières de la Colombie-Britannique et cherchons à définir les facteurs caractérisant leurs divers styles, stratégies et techniques de pression. Nous tentons également d'évaher I'effet de ces styles et stratégies de pression sur les politiques publiques queles groupes ont cherchéà influencer, tout en sachant que le gouvernement essaie également d'influencer le comportement des groupes. Nous en venons à la conclusion qu'il existe six facteurs critiques, certains exogènes, d'autres endogènes, qui influencent fortement le comportement des organismes de santé en tant que groupes de pression. Ces facteurs sont les suivants: nature des membres du groupe, orientation de leurs activités au sein du groupe, cycle des interactions groupe-gouvernement, durée de I'expérience du groupe avec le gouvernement comme principal bailleur de fonds, présence ou absence de relations harmonieuses au sein du groupe, et enfin valeurs et attitudes des divers membres en fonction de leur intégration sociale.     

Ethics Consultation

As part of the journal's effort to give readers practical applications in health care, we present the following regular feature. We hope that all readers will find something of interest in this and subsequent case studies, and, with the authors, we welcome your feedback. Ed.     

Disbursement,decentralization and development: Lessons from the first rural health services project in Papua New Guinea

In 1983 the Department of Health in Papua New Guinea decentralized the control of health services to provincial governments. In the same year a major rural health development project commenced in six of the nineteen provinces. Conflict arose between the centralized control required by the project and the decentralized health system. This article reviews the experience of the project implementators in trying to reconcile the philosophy and reality of decentralization with the centralized project design. Lessons point to the need for closer collaboration with beneficiaries during project design, formal clarification of responsibilities of national and provincial governments in implementation, institutional strengthening as a project input and the development of mechanisms for review and change during the course of implementation.     

Distinguishing Absentee Students from Regular Attenders: The Combined Influence of Personal,Family, and School Factors

In the present study, the relationship between student attendance and personal characteristics of the student, the student's family relations, and school variables were examined in a sample of 54 high school students. Consistent with earlier reports, t-tests revealed statistically significant relationships between school absence and many student, family, and school variables. The data were also analyzed using a stepwise discriminant analysis. The results showed that the absentee and regular attending students could be distinguished based on a combined set of 6 variables representing each of the three domains of student, family, and school characteristics. The results further revealed that several variables that were statistically significant in the univariate analyses failed to be retained in the discriminant analysis, suggesting that these variables did not contribute sufficient unique variance to warrant their inclusion in the discriminant function. The implications of school absence as a multifactored problem is discussed with respect to assessment and treatment effectiveness.     

Separation-individuation and ego identity status in late adolescence: A two-year longitudinal study

This study was undertaken to clarify developmental relationships between intrapsychic object relations structure and ego identity status during late adolescence; one purpose was to examine the possible predictive relationship between initial attachment style and later identity status. A total of 76 subjects (41 females and 35 males) who had been given the Marcia Ego Identity Status Interview and the Hansburg Separation Anxiety Test (SAT) as first-year university students in 1984 were reassessed two years later. Fitted log linear models indicated strong links between attachment style and identity status in 1986, and between identity status in 1984 and 1986; only an indirect connection existed between attachment style in 1984 and 1986 as measured by the SAT. When 1984 and 1986 identity status were known, it was possible to predict 1986 attachment style without knowing 1984 attachment style; 1984 attachment style alone was unable to predict later identity status accurately.This research was supported by a grant from the Internal Research Committee, Victoria University of Wellington.Received Ph.D. in Child Development from the Florida State University. Current research interest is identity formation from a life-span perspective.Received Ph.D. in Mathematical Statistics from Victoria University of Wellington. Among current research interests is the analysis of sparse contingency tables.     

The hijacking of a new corporate form? Benefit corporations and corporate personhood

Benefit corporations are a new type of corporate entity developed to remedy antisocial corporate behaviour by enabling mission-driven investors, managers and entrepreneurs to prioritize social values and contest the idea that profits are the only and best measure of corporate performance. To resocialize the corporate entity, the benefit corporation movement built enabling discourses and evaluation practices into the dominant model of corporate governance, shareholder value ideology. These discourses and practices expand both the purpose of the corporate entity and shareholders’ power to enforce that purpose. However, this paper argues that the effort to ‘re-embed’ the corporate entity by making it subject to non-economic claims expands the scope of corporate personhood and that doing so within extant power relations of the firm opens the door to alternative projects that undermine the benefit corporation movement's goal of fostering corporate social responsibility.