Interest group governance and policy agendas

Abstract

This article proposes that the internal political organization of an interest group can shape its policy agenda. In doing so, it recommends that public policy research draw on scholarship on comparative political institutions to identify and theorize how alternative organizational rules, structures, and mechanisms can shape preference formation and expression. For example, confederal interest groups can amplify minority voices, whereas majoritarian groups can silence them. Contrasting cases of physician advocacy in mental health policy illustrate how the confederal approach to medical organization in France expanded the influence of a small group of public sector psychiatrists; while the majoritarian, “winner‐take‐all” approach to medical organization in the United States sidelined their American counterparts in favor of the private sector majority. These findings suggest that the politics of interest‐aggregation merit further investigation.

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

“…Psychiatric hospitals may not be the only institution anchoring French psychiatric specificity, which speaks to the flexibility of the concept. The fragmented, confederal organization of French interest groups have allowed public psychiatrists to pursue their autonomy independently of increasingly heteronomous private practitioners, who were more dominant in the centralized American medical interest group system (Perera 2022). French universities offer no clinical training to social workers and French national insurance does not pay for treatment by psychologists, and both of these factors limit the direct challenges psychiatrists faced to their jurisdiction.…”

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy

“…However, our experience suggests that primarily relying on umbrella organisations as respondents results in a limited understanding of health worker challenges and policy priorities. For example, the national umbrella association in a mixed health system context might have greater representation of members working in the private sector rather than the public sector; engaging with public sector doctors’ association might, therefore, provide an additional and arguably more nuanced understanding of issues experienced by those doctors 22. In another example, umbrella organisations might not speak to the demands of cadres organised around particular employment terms, such as contract work, and organisations founded to address these concerns (eg, the National Health Mission In-source Employees’ Association in India) would provide specific insights into the grievances and demands of those cadres.…”