Do We Really Want to Know? The Potentially Negative Effect of Transparency in Decision Making on Perceived Legitimacy

Building on the notion of transparency as a strong democratic value and theories of procedural justice, this article reports an explorative experimental test whether transparency in decision making may lead to increased perceived legitimacy in terms of decision acceptance and trust. This is done in a context of difficult decisions of high importance for citizens - namely priority setting in public health care. An experiment was designed in which ordinary citizens were presented with a description of a case of priority setting between two groups with different health care needs. One group was given no information at all on the decision-making procedure, as an example of non-transparent decision making, and six groups were presented with different descriptions of the decision-making procedure, as examples of transparency in decision making. The transparent procedures were derived from three basic forms of democratic decision making: representation, direct participation and expert decision making. A second manipulation framed the decision-making procedure alternatively in positive or negative terms in order to capture media framing effects as well. According to the findings of the study, transparent decision-making procedures tend to weaken rather than strengthen general trust in health care - a finding that might reveal obstacles to attempts to strengthen the legitimacy of health care by employing transparent procedures. The results also show that while the form of decision making had no significant impact on perceived legitimacy, positive or negative framing of a decision-making procedure influences public perceptions of both the procedure and the decision outcome.