Legacies of Centralism: Governance Challenges for Health & Health Care in Chile

• In Event: Comparative Politics of Health: Popular Demands, Institutional Legacies

Abstract

Implementation is a problem everywhere, but the problem takes many forms in different political systems. We focus on the governance challenges associated with extending an effective universal health care scheme in a traditionally centralized, segmentalist system such as is often found in Latin America and Southern Europe. Our case is the implementation of the Chilean explicit guarantees for health program (AUGE), which created management challenges for local health authorities charged with implementation. We use the TAPIC model of governance developed by the European Observatory on Health Systems and Policies to interpret in-depth interviews with fourteen health policymakers in a single region about the challenges they faced. They report that centralized accountability and weak local participation inhibit adaptation and local coordination and express worries about their capacity to effectively use greater autonomy due to lack of policy capacity. We can see some benefits of centralization in the relatively transparency and lack of corruption problems in the system. The question is how to increase local accountability and coordination without losing the benefits of the existing system.

Authors

• Claudio A. Méndez, Universidad Austral de Chile

• Scott L. Greer, University of Michigan