The Subnational Political Economy of Public Health Administration in Chile

• In Event: Overcoming Uneven Welfare States: The Politics of Welfare Reform in Latin America

Abstract

Latin American states exhibit wide subnational variation with regard to the presence and strength of public healthcare institutions. Indeed, the extent to which the central state has effectively penetrated the territory and established functional public health institutions varies within most Latin American countries, even in highly centralized, high-capacity states such as Chile. This paper seeks to understand why such variation exists, focusing on the foundational moment of Chile’s national healthcare system, the SNS, in 1952. Drawing on newly discovered historical archives, I analyze the origins of the SNS. I find that the system was implemented unevenly across the territory, favoring state-building in Chile’s central and southern regions at the expense of the mineral-rich northern territories. The analysis reveals that these disparities resulted from national-level political-economic constraints and distinct subnational power configurations in mid-20th century Chile. The paper uses process tracing to provide evidence of this causal process, contributing to the literature on state-building, Latin American welfare states, and subnational politics.

Author

• Jennifer Pribble, University of Richmond