Perceptual Bias and Public Programs: The Case of the United States and Hospital Care

• Author: Austin P. Johnson,Kenneth J. Meier,Seung‐Ho An
• Published date: 01 November 2019
• DOI: http://doi.org/10.1111/puar.13067
• Date: 01 November 2019

820 Public Administration Review • Novem ber | Dece mber 2 019

Public Administration Review,

Vol. 79, Iss. 6, pp. 820–828. © 2019 by

The American Society for Public Administration.

DOI: 10.1111/puar.13067.

Seung-Ho An is assistant professor

of public management in the School of

Government and Public Policy, University

of Arizona. His research interests include

management and diversity issues in public

and nonprofit organizations, representation,

bureaucratic politics, organizational

behavior, and research methods.

E-mail: seunghoan@arizona.edu

Austin P. Johnson is a PhD candidate in

the Department of Political Science at Texas

A&M University. His research focuses on tax

policy, social psychology, and experimental

methodology.

E-mail: john31860@tamu.edu

Abstract: This article examines whether the public holds biased perceptions of public organizations (in this case,

hospitals) in the United States and whether organizations get credit for positive results from program evaluations.

Using an experimental design that replicates Hvidman and Andersen’s 2016 Danish study, the study finds no negative

public sector biases in the United States, but organizations are not given any credit for positive program evaluations.

These results hold in two experimental replications. The implications of the findings for the measurement of public

perceptions of government programs and for effective democratic governance are discussed.

Evidence for Practice

• Performance appraisal results generated by an agency do not appear to affect public evaluations of that

agency.

• U.S. public hospitals are not perceived more negatively than private hospitals in terms of efficiency,

effectiveness, red tape, or benevolence.

• Experiments on citizen evaluation need to be replicated in specific agency and national contexts.

• Practitioners need to be especially careful about arguments related to efficiency and whether reliable

measures of efficiency are possible.

The ability of citizens to evaluate the

performance of government and public

programs is a prerequisite for democratic

governance (Achen and Bartels 2017; Pande 2011).

Citizens are expected to judge government policies

and programs and vote accordingly (Downs 1957),

thus linking the recent performance management

movement (Moynihan 2008; Sanderson 2001) to

larger questions of governance. Although a modest

literature has documented the matchup or lack of

matchup between citizen assessments of programs

and official government measures of performance

(see Andrews, Boyne, and Walker 2006; Song and

Meier 2018 and the references cited therein), this

literature cannot distinguish whether a lack of

congruence results because citizens have different

objectives than government programs or because

citizens are unable to judge the quality of government

programs. Of particular concern is the inability to

evaluate programs, or the unwillingness to do so,

that might result from other causes, such as the

basic perceptual biases that psychologists have found

that most individuals have (Tversky and Kahneman

1981). Similar biases in public perceptions have

been found in the growing literature on behavioral

public administration (Baekgaard and Serritzlew

2016; Battaglio et al. 2019; Bellé, Cantarelli, and

Belardinelli 2018; Charbonneau and Van Ryzin

2015; James 2011a, 2011b; James et al. 2016; Marvel

2015a, 2015b; Olsen 2017; Riccucci, Van Ryzin, and

Lavena 2014; Riccucci, Van Ryzin, and Li 2016).

A recent article in Public Administration Review by

Hvidman and Andersen (2016) found negative views

of the public sector. That experiment had students in

Denmark evaluate hospitals on several dimensions. It

showed that the students had a more negative view of

the public sector in terms of efficiency, effectiveness,

and red tape and modestly more positive assessments

on benevolence.1 Hvidman and Andersen framed

the Danish context as enhancing the theoretical and

substantive significance of the findings, suggesting

that Denmark is one of the least likely nations to

harbor anti–public sector biases. Health care in

Denmark is a government-funded entitlement and

corresponds with an elaborate public sector social

net for its citizens; the Danish government spends

54.8 percent of gross domestic product (GDP), the

third highest among Organisation for Economic

Co-operation and Development (OECD) countries

(only France and Finland spend more; OECD 2018).

Bureaucrat bashing in Denmark is relatively modest,

according to Hvidman and Andersen, so they present

Denmark as a hard case. If negative perceptions of the

Kenneth J. Meier

American University, Cardiff University, and Leiden University

Austin P. Johnson

Texas A&M University

Seung-Ho An

University of Arizona

Kenneth J. Meier is distinguished

scholar in residence in the School of Public

Administration, American University,

Washington, D.C. He also hold faculty

positions in the Cardiff School of Business,

Cardiff University (Wales) and Leiden

University (the Netherlands). His current

research interests include questions of

representation and equity in regard to

race and ethnicity and the role that public

program management has on effective

governance.

E-mail: kmeier@american.edu

Perceptual Bias and Public Programs: The Case of the

UnitedStates and Hospital Care

Research Article