Public Service Delivery

• Do diminishing public services create political grievances that increase support for right-wing populism?
  • Literature on the drivers of populism have focused primarily on economic (Margalit 2019) and cultural grievances (Norris and Inglehart 2019)
  • Much less work on how direct experiences with poor public service provision may affect support for the populist right
• If public service decline creates grievances, how do voters respond?
  • Do they punish the incumbent?
  • Do they shift to the party that “owns” the issue of public services?
  • Do they shift to the populist right?
  • Are the effects of declines conditioned by other factors, such as immigration?

Public Service Delivery

• Public service delivery is a core function of the state
  • Key to the social contract between representatives and voters (Besley 2020)
  • Key to the legitimacy of the state (Levi 1988)
  • Key to the quality of life of citizens (Vogler 2023)
• Public services are often the primary means through which citizens interact with and learn about the state’s performance
  • Even citizens uninterested or uninformed about politics are likely to have direct experiences with public services

The argument

• Declines in public service delivery can generate public dissatisfaction and grievances
• Shift to the populist right can occur for several reasons:
  • As a protest vote against the establishment for failure to uphold the social contract
  • When linked with cultural arguments about competition for scarce public services with immigrants
    • Validates the populist right’s anti-immigrant rhetoric

Theoretical Expectations

1. Declining public services will reduce patients’ reported experiences
2. Declining public services will increase support for the populist right among affected voters
3. The effects of declining public services will be more pronounced when such declines can be linked to an increase in immigration

Data

• GP practice closures in England from NHS Digital
• GP-Patient Survey from Ipsos
  • Practice-level data on patient experience and satisfaction
• Understanding Society Panel (Secure Access)
• British Election Study Panel
• Annual data on migration from Office of National Statistics (ONS)

Causal Identification

• We want to identify the causal effect of experiencing a GP practice closure on outcomes of interest
  • Yet, closures are not random (recruitment issues, health outcomes, etc.)
  • We need to control for confounding factors
• Treatment group: individuals in areas where a GP practice has closed
• Control group: individuals in areas where a GP practice has not yet closed
• We use a staggered difference-in-differences design
  • Geographic and Temporal Variation

Treatment & Control Groups

• We compare outcomes among individuals in areas that experience a closure to outcomes in areas where individuals have not yet experienced a closure

GP Practice Closures

GP Practice Closures

• Millions of patients have been affected by practice closures

Estimation

• We estimate the effect of GP practice closures on outcomes of interest using a variety of estimation strategies:
  • Matrix Completion (Athey et al. 2021)
  • Interactive Fixed Effects (Bai 2009)
  • Mahalanobis Matching (Imai, Kim, and Wang 2023)
  • Covariate-balancing Propensity Score Matching (Imai and Ratkovic 2014)
  • Random Forests (for heterogenous treatment effects)

Results

Results are presented as event series plots, where the event is the closure of a GP practice and the y-axis is the estimated coefficient at time t relative to the event

Patient Experiences

• The Effects of Practice Closures on Patient Experiences in Neighboring Practices (GP Patient Survey Data)

Vote Intention

The Effects of Practice Closures on Vote Intention for a Populist Right Party (Understanding Society Panel Data)

Vote Intention

The Effects of Practice Closures on Vote Intention for a Populist Right Party (BES Panel Data)

Do Voters Move to Labour?

Do Voters Move to Labour?

Conditional Treatment Effects

• The effects of declining public services are more pronounced when such declines can be linked to an increase in immigration
• When voters perceive that immigrants are competing for scarce public services, they are more likely to shift to the populist right
  • This is consistent with the populist right’s anti-immigrant and nativist rhetoric

Conclusions

• Robust evidence that direct experience with deteriorating public services increases support for the populist right
• Rather than shifting support to the party that “owns” the issue of public services (e.g. Labour), voters turn against ‘mainstream’ parties
• Populist right parties can capitalize on dissatisfaction with public service delivery to increase their support
  • Particularly when the decline in public services can be linked to an increase in immigration
  • anti-establishment, anti-immigrant/nativist rhetoric
• Key Takeaway: In addition to economic and cultural factors, we should also consider how poor performance of core public services fuels populist right support