Two Paths to Reform: Parties and Technocrats in Latin American Healthcare Policy

• In Event: Comparative Historical Perspectives on the State and Policy Reform

Abstract

Reforms of their underfunded and highly inegalitarian healthcare systems rose high on the agenda of most Latin American countries by the beginning of the 21st century. Most countries did introduce reforms. Yet not all reforms were created equal. This book innovates upon previous scholarship by showing that the political process behind the formation of these reforms severely affected their success. When political parties were highly committed to the reform, these were better planned and more sustainable. I show that the programmatic commitment of political parties is a crucial explanatory factor in the quality of legislation. Reforms can follow a path in which parties shape specifications regarding implementation and funding or one in which disengaged parties let technocrats without partisan ties dominate the policymaking process. Both paths can lead to an increase in formal coverage and even a rise in funding for the healthcare sector. However, the key difference between the two paths is the feasibility of granting effective access to healthcare and the sustainability of the necessary funding to deliver these benefits. This study provides an in-depth analysis of the healthcare reform processes in Chile, Mexico, and Peru that began in the 2000s, analyzing the entire policymaking process, from agenda-setting and debate to implementation in the short and long run. It draws on twelve months of extensive field research, during which I conducted over 150 in-depth interviews with political elites, technocrats, and leaders of interest groups.

Author

• Zoila Ponce de León, University of Pittsburgh