Scope of Medical Practice and the Legislative Process: Four Case Studies in Exchange Theory from the 1981-1982 California Legislature (Interest Group, Politicking).

Abstract

The aim of this dissertation is to provide a framework for underst and ing legislative processes and predicting legislative outcomes. Based on the political economy theory of legislation, the study assumes that the legislative marketplace may be characterized as a transaction between dem and ers for and suppliers of legislative outputs. Following a general interdisciplinary review of the literature on legislative processes, voting behaviors, and interest groups, a theoretical construct is presented with applications to the health care field. Specifically, it is hypothesized that those interest groups who have the highest effective dem and pattern will receive the most benefits from the legislative exchange. To operationalize this, four dem and characteristics were chosen: organizational integration, lobbying activities, campaign fund contributions, and media coverage. Additionally, a set of alternative hypotheses which included variables such as party, ideology, incumbency, age, leadership position, committee assignments, margin of electoral victory during the last election, the socioeconomic status of an urban or rural electoral district, and the electoral homogeneity of a district were all tested as possible factors in explaining a particular legislative outcome. The study focuses on the 1981-1982 California Legislature by selecting four medical scope of practice bills presented as separate case studies: licensed vocational nursing, nurse midwifery, nurse anesthetist, and chiropractic. All of these were viewed as salient, some more controversial than others, economic turf battles among the various medical professions. In three of the four case studies, the proposed theoretical construct failed to correctly predict the actual responses of the Legislature. In all of these three cases, it was argued that particular individual interests were more instrumental in determining the final terms of the legislative exchange than any one of the above variables. The study concludes by noting that although the exchange theory may still be a valid approach for researching the outcome of legislative processes at the aggregate level of analysis, it is no substitute for the wealth of details and insights gathered from case studies. The study does, however, further emphasize the need to focus on the individual players and their roles in the legislative marketplace.