CHILES HEALTH SECTOR REFORM - LESSONS FROM 4 REFORM PERIODS

This paper applies an interdisciplinary approach to analyze the proces s of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 19 20s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of h ealth insurance in the 1980s, and (4) the strengthening of the mixed p ublic-private market in the 1990s. Building on the authors' separate d isciplines, the paper examines the epidemiological, political and econ omic contexts of these reforms to test simple hypotheses about how the se factors shape reform adoption and implementation. The analysis unde rlines: (1) the importance of epidemiological data as an impetus to pu blic policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms; and (3) the importance of the congruen ce of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themse lves, exploring the role of antecedents, interest groups, and consensu s-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. Howeve r, interest group politics and consensus building were found to be com plex processes that are not easily captured by the simple hypotheses t hat were tested. The interdisciplinary approach is found to be a promi sing form of analysis and suggests further theoretical and empirical i ssues to be explored.