Who Governs? The Politics of Health Policy in Chile, Brazil, and Uruguay

• In Event: Social Policy and Social Spending in Comparative Perspective

Abstract

When health officials in Brazil interrupted a key match against Argentina to enforce quarantine regulations, asserting their priority as state officers over the officials on the field, their intervention raised crucial questions of autonomy and authority. Who governs? And, crucially, how? Good governance and the quality of public sector organizations have long been a subject of scholarly attention. From Evans’ “embedded autonomy” to Geddes highlighting the “politician’s dilemma,” a wide-ranging literature on government effectiveness within sociology, economics, and political science argues that the capacity and autonomy of public officials influence the effectiveness of public organizations. Yet what is meant by autonomy remains frustrating vague and entirely overlooks other forms of autonomy highlighted by legal scholars, such as ex ante procedural limitations on discretionary authority and ex post review. In this paper, I argue that effective governance vitally depends on the configuration of autonomy. I substantiate this argument by tracing the development and implementation of particular health policies in Chile, Brazil, and Uruguay. These countries have strong mechanisms for meritocratic recruitment, but who governs and how looks very different. Drawing on both survey data, detailed process tracing, and a natural experiment, I show that the way legal frameworks have been imported and evolve influences expertise, accountability, and participation.

Author

• Katherine Bersch, Davidson College