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Do Far-Right Mayors Promote Informal Healthcare Chauvinism?

Ethnic Discrimination in Access to Basic Healthcare in Italy

Krzysztof Krakowski, Dina Rosenberg, Alessio Romarri, and Merlin Schaeffer

2022-10-24

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The far-right and welfare chauvinism

A system of social protection for those who belong to the ethnically defined community

Kitschelt and McGann (1997)

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The far-right and welfare chauvinism

A system of social protection for those who belong to the ethnically defined community

Kitschelt and McGann (1997)


Two examples of welfare chauvinistic policy in Denmark:
(Jørgensen and Thomsen, 2016)

  • Direct: "Start Aid": Ca. 50% lower benefits to refugees & recent immigrants.

  • Indirect: "225 hour rule": Both partners in a union need to have worked 225+ hours in the past 12 months to qualify for benefits.


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The far-right and welfare chauvinism

A system of social protection for those who belong to the ethnically defined community

Kitschelt and McGann (1997)

Danes' public opinion on who should to get vaccinated first Source: Schaeffer and Haderup Larsen (2022)

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The far-right and welfare chauvinism

A system of social protection for those who belong to the ethnically defined community

Kitschelt and McGann (1997)

Quality of written answers
from German welfare office administrators
Source: Hemker and Rink (2017)

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Do far-right mayors
promote informal healthcare chauvinism?

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Do far-right mayors
promote informal healthcare chauvinism?

Potential mechanisms

  1. Informal policy.
  2. Hiring.
  3. Erosion of social norms.
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A field experiment

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A field experiment

Research assistants call 200
Italian "Azienda Sanitaria Locale"
to ask for a general practitioner

Two students with
West-African accent

Two students with
native Italian accent

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Interview guideline

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Ethnic discrimination in access to basic healthcare

Note: Means with 90 and 95% CI. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Ethnic discrimination in access to basic healthcare

Note: Means with 90 and 95% CI. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Ethnic discrimination in access to basic healthcare

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects.

Note: Means with 90 and 95% CI. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Ethnic discrimination by far-right mayors

Note: Means with 90 and 95% CI. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Ethnic discrimination by far-right mayors

Note: Means with 90 and 95% CI. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Ethnic discrimination by far-right mayors

Municipalities where far-right candidates ran
versus where they won
Source: Romarri (2020)



Note: Means with 90 and 95% CI.
n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Far-right mayors A regression discontinuity design

Note: n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Balanced confounders around the margin of victory

Source: Romarri (2020)

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Far-right mayors A regression discontinuity design

Note: OLS with 90 and 95% CI fitted separately on each side of the margin of victory. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Far-right mayors A regression discontinuity design

Note: OLS with 90 and 95% CI fitted separately on each side of the margin of victory. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Far-right mayors a Diff-in-RD design

Bias-corrected non-parametric RD with optimized bandwidth (Calonico, Cattaneo, and Titiunik, 2014)

RD among callers with native Italian accent

# Sharp RD estimates using local polynomial regression.
#
# Number of Obs. 391
# BW type mserd
# Kernel Triangular
# VCE method NN
#
# Number of Obs. 116 275
# Eff. Number of Obs. 32 88
# Order est. (p) 1 1
# Order bias (q) 2 2
# BW est. (h) 3.035 3.035
# BW bias (b) 6.032 6.032
# rho (h/b) 0.503 0.503
#
# =============================================================================
# Method Coef. Std. Err. z P>|z| [ 95% C.I. ]
# =============================================================================
# Conventional -0.026 0.021 -1.257 0.209 [-0.066 , 0.014]
# Bias-Corrected -0.039 0.021 -1.892 0.058 [-0.079 , 0.001]
# Robust -0.039 0.023 -1.669 0.095 [-0.085 , 0.007]
# =============================================================================
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Far-right mayors a Diff-in-RD design

Bias-corrected non-parametric RD with optimized bandwidth (Calonico, Cattaneo, and Titiunik, 2014)

RD among callers with native Italian accent

# Sharp RD estimates using local polynomial regression.
#
# Number of Obs. 391
# BW type mserd
# Kernel Triangular
# VCE method NN
#
# Number of Obs. 116 275
# Eff. Number of Obs. 32 88
# Order est. (p) 1 1
# Order bias (q) 2 2
# BW est. (h) 3.035 3.035
# BW bias (b) 6.032 6.032
# rho (h/b) 0.503 0.503
#
# =============================================================================
# Method Coef. Std. Err. z P>|z| [ 95% C.I. ]
# =============================================================================
# Conventional -0.026 0.021 -1.257 0.209 [-0.066 , 0.014]
# Bias-Corrected -0.039 0.021 -1.892 0.058 [-0.079 , 0.001]
# Robust -0.039 0.023 -1.669 0.095 [-0.085 , 0.007]
# =============================================================================

RD among callers with West-African accent

# Sharp RD estimates using local polynomial regression.
#
# Number of Obs. 421
# BW type mserd
# Kernel Triangular
# VCE method NN
#
# Number of Obs. 136 285
# Eff. Number of Obs. 26 72
# Order est. (p) 1 1
# Order bias (q) 2 2
# BW est. (h) 2.330 2.330
# BW bias (b) 4.301 4.301
# rho (h/b) 0.542 0.542
#
# =============================================================================
# Method Coef. Std. Err. z P>|z| [ 95% C.I. ]
# =============================================================================
# Conventional -0.536 0.178 -3.012 0.003 [-0.885 , -0.187]
# Bias-Corrected -0.616 0.178 -3.457 0.001 [-0.964 , -0.267]
# Robust -0.616 0.196 -3.146 0.002 [-0.999 , -0.232]
# =============================================================================
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Far-right mayors a Diff-in-RD design

Bias-corrected non-parametric RD with optimized bandwidth (Calonico, Cattaneo, and Titiunik, 2014)

RD among callers with native Italian accent

# Sharp RD estimates using local polynomial regression.
#
# Number of Obs. 391
# BW type mserd
# Kernel Triangular
# VCE method NN
#
# Number of Obs. 116 275
# Eff. Number of Obs. 32 88
# Order est. (p) 1 1
# Order bias (q) 2 2
# BW est. (h) 3.035 3.035
# BW bias (b) 6.032 6.032
# rho (h/b) 0.503 0.503
#
# =============================================================================
# Method Coef. Std. Err. z P>|z| [ 95% C.I. ]
# =============================================================================
# Conventional -0.026 0.021 -1.257 0.209 [-0.066 , 0.014]
# Bias-Corrected -0.039 0.021 -1.892 0.058 [-0.079 , 0.001]
# Robust -0.039 0.023 -1.669 0.095 [-0.085 , 0.007]
# =============================================================================

RD among callers with West-African accent

# Sharp RD estimates using local polynomial regression.
#
# Number of Obs. 421
# BW type mserd
# Kernel Triangular
# VCE method NN
#
# Number of Obs. 136 285
# Eff. Number of Obs. 26 72
# Order est. (p) 1 1
# Order bias (q) 2 2
# BW est. (h) 2.330 2.330
# BW bias (b) 4.301 4.301
# rho (h/b) 0.542 0.542
#
# =============================================================================
# Method Coef. Std. Err. z P>|z| [ 95% C.I. ]
# =============================================================================
# Conventional -0.536 0.178 -3.012 0.003 [-0.885 , -0.187]
# Bias-Corrected -0.616 0.178 -3.457 0.001 [-0.964 , -0.267]
# Robust -0.616 0.196 -3.146 0.002 [-0.999 , -0.232]
# =============================================================================

ΔRDD=0.616(0.039)=0.577

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Far-right mayors a Diff-in-RD design

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Far-right mayors a Diff-in-RD design

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

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Nr. of questions asked by administrator (0 - 10)

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 806 telephone calls (resp. 391 & 415) to 252 municipalities.

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Nr. of questions asked by administrator (0 - 10)

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 806 telephone calls (resp. 391 & 415) to 252 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. n = 806 telephone calls (resp. 391 & 415) to 252 municipalities.

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Nr. of irrelevant questions asked by administrator (0 - 4)

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 805 telephone calls (resp. 392 & 413) to 252 municipalities.

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Nr. of irrelevant questions asked by administrator (0 - 4)

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 805 telephone calls (resp. 392 & 413) to 252 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. n = 805 telephone calls (resp. 392 & 413) to 252 municipalities.

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Conclusion

  1. Immigrant minorities face discrimination in access to basic healthcare.
    At least those with a West-African accent.

  2. Far-right mayors promote this type of discrimination.

  3. Next step: 3 Mechanisms.

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Conclusion

  1. Immigrant minorities face discrimination in access to basic healthcare.
    At least those with a West-African accent.

  2. Far-right mayors promote this type of discrimination.

  3. Next step: 3 Mechanisms.

Source: Romarri (2020)

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Implications

For immigrant minorities

  • More exploratory qualitative and field experimental work on further informal channels of welfare chauvinism.
  • Excess prevalence of diseases that need preventive healthcare?
  • Benefits and dangers of digitized administration?
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Implications

For immigrant minorities

  • More exploratory qualitative and field experimental work on further informal channels of welfare chauvinism.
  • Excess prevalence of diseases that need preventive healthcare?
  • Benefits and dangers of digitized administration?

For everyone

  • "No one is safe until everyone is safe"
    (Farrar and Ahuja, 2021)
    • Pre-reg hypothesis: Far-right mayors increased excess death rate during first wave Italian COVID-19 pandemic.
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Thank you for your attention!

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References

Calonico, S., M. D. Cattaneo, and R. Titiunik (2014). "Robust Nonparametric Confidence Intervals for Regression-Discontinuity Designs: Robust Nonparametric Confidence Intervals". In: Econometrica, pp. 2295-2326.

Farrar, J. and A. Ahuja (2021). Spike: The Virus vs. The People - the Inside Story. Profile Books.

Hemker, J. and A. Rink (2017). "Multiple Dimensions of Bureaucratic Discrimination: Evidence from German Welfare Offices". In: American Journal of Political Science, pp. 786-803.

Jørgensen, M. B. and T. L. Thomsen (2016). "Deservingness in the Danish context: Welfare chauvinism in times of crisis". In: Critical Social Policy, pp. 330-351.

Kitschelt, H. and A. J. McGann (1997). The radical right in Western Europe: A comparative analysis. Michigan: University of Michigan Press.

Romarri, A. (2020). Do Far-Right Mayors Increase the Probability of Hate Crimes? Evidence From Italy. SSRN Scholarly Paper ID 3506811. Rochester, NY: Social Science Research Network.

Schaeffer, M. and M. Haderup Larsen (2022). "Who Should Get Vaccinated First? Limits of Solidarity during the First Week of the Danish Vaccination Programme". In: European Sociological Review, p. jcac025.

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Appendix

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Binary success "Yes" & "Probably yes": 1; else: 0

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.
n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

20 / 22

Binary success "Yes", "Probably yes", or "Don't know": 1; else: 0

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.
n = 812 telephone calls (resp. 391 & 421) to 257 municipalities.

20 / 22

Perfectly balanced data

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 54 regions. Adjusted for gender of the caller and municipality fixed effects. n = 492 telephone calls (resp. 246 & 246) to 123 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.
n = 492 telephone calls (resp. 246 & 246) to 123 municipalities.

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Balanced data

Note: Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. n = 686 telephone calls (resp. 343 & 343) to 220 municipalities.

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.
n = 686 telephone calls (resp. 343 & 343) to 220 municipalities.

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Single rule versus in coalition

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.

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La Lega

Note: ΔRDD estimates based on rdrobust() with 90 and 95% BCa confidence intervals (capped at -2) based on 2,000 bootstrap samples stratified by Italian/West-African accent.

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RDD 1st election round

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RDD 2nd election round

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The far-right and welfare chauvinism

A system of social protection for those who belong to the ethnically defined community

Kitschelt and McGann (1997)

2 / 22
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