Chile's health sector reform: lessons from four reform periods
| Autor: | Jorge Jimenez de la Jara, Thomas J. Bossert |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
medicine.medical_specialty
Civil society National Health Programs Health Policy media_common.quotation_subject Public health Politics Public policy Public Policy History 20th Century Public administration Privatization Decentralization Recession State Medicine Health Care Reform Economics medicine Humans Ideology Child Public Health Administration Health policy media_common |
| Zdroj: | Health Policy. 32:155-166 |
| ISSN: | 0168-8510 |
| DOI: | 10.1016/0168-8510(95)00733-9 |
| Popis: | This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of the epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms; and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored. |
| Databáze: | OpenAIRE |
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