Health Policy in Chile: The Return of the Public Sector?

Health policy in Chile has mirrored the main changes in economic policy in recent times. The 1950s and 1960s witnessed centralisation of public health care into a National Health Service. Neoliberal policies in the 1970s and 1980s refocused health policy onto extending the scope for private insurance and provision in health care. The return to democracy in 1990 has produced a reappraisal of health policy, with the emphasis on strengthening and improving public health insurance and care. This paper examines the extent to which recent changes in health policy signal a reappraisal of the private-public mix in the provision of basic services, and argues that a model for health care and financing built around a strong, modern, and efficient, public health care sector is more likely to succeed in addressing the health needs of the population in Chile and Latin America.     

Democracy and Social Policy in Brazil: Advancing Basic Needs, Preserving Privileged Interests

Has democracy promoted poverty alleviation and equity‐enhancing reforms in Brazil, a country of striking inequality and destitution? The effects of an open, competitive political system have not been straightforward. Factors that would seem to work toward this goal include the voting power of poor people, the progressive 1988 Constitution, the activism of social movements, and governance since 1995 by presidents affiliated with center‐left and left parties. Yet these factors have been counterbalanced by the strong political influence and lobbying power of organized interests with a stake in preexisting arrangements of social protection and human capital formation. An analysis of four key federal sectors, social security, education, health care, and public assistance, illustrates the challenges for social sector reforms that go beyond raising basic living standards to enhancing socioeconomic inequality.     

Rich doctors and poor patients: Market failure and health care systems in developing countries

This article argues that, in developing countries, health care systems (HCS) have been facing the problem of market failure, implying that the fair rules of market principles do not apply and patients often become losers. Explaining the theoretical issues involved, the article examines various causes of market failures in HCS, including: rent-seeking activities by doctors, asymmetric information between doctors and patients, between patients and insurance companies, and the oligopolistic behaviour of health care practitioners. The policy implications of the study suggest that, in many cases, government intervention is essential to eliminate market failures in the HCS in developing countries.     

More with Less? Fiscal Decentralisation,Public Health Spending and Health Sector Performance

Decentralisation is considered a panacea for deficient public sector performance by many. However, recent trends of health sector recentralisation in several OECD countries suggest the opposite. Taking on a cross‐country perspective, I examine two hypotheses, namely that decentralisation leads to an increase in public health spending (H1) and to poor health sector outcomes (H2). The evidence I present suggests that decentralising spending tends to lead to larger public health sectors and to poorer health sector outcomes. However, decentralising tax authority has no effect on the size of the health sector and may actually have a positive effect on health sector performance. The broader lesson is that while general fiscal decentralisation research tends to imply that its conclusions are valid for all policy areas in a similar way, sector‐specific insights can reveal a more nuanced view on the consequences of fiscal decentralisation.     

Mubarak's Constitutional Reforms

Egypt's President, Hosni Mubarak, is noted for having perfected the art of seemingly introducing reforms while actually consolidating his autocratic rule. In response to domestic and international pressure, he has recently introduced further reforms, in the hope of silencing the opposition and officially rectifying Egypt's poor human rights record. In his speeches and public statements, Mubarak has promised to set Egypt on the road to freedom, human rights, and democracy. He has established a National Council for Human Rights, more freedom for political parties and the press, and a series of constitutional amendments liberalising presidential elections and allowing more democracy, with a great deal of fanfare. This paper will consider the significance in reality of these constitutional amendments, particularly as regards human rights and democracy, the powers of the president and the role of non-governmental organisations and ordinary citizens in decision making. We conclude that, welcome as they are, the reforms have so far not been effective in moderating the president's absolute authority, neither have they lived up to public expectations. Whatever reform measures the Egyptian government has reluctantly introduced have been drained of any real substance by legal stratagems or hedged with all sorts of restrictions.     

South European Healthcare Systems under Harsh Austerity: A Progress–Regression Mix?

This article addresses the question of whether the economic crisis provides a politically opportune time to drastically curtail public healthcare in South Europe or whether, instead, there are signs of longer-term reform strategies for potentially balancing fiscal targets with the quest for enhanced value and health outcomes, when eventually growth resumes. After a brief examination of the profile of healthcare systems in Greece, Italy, Portugal and Spain prior to the crisis, we comparatively assess the mix of retrenchment, restructuring and recalibration strategies. The effects of the austerity-driven reforms on current (and expected) health outcomes are also briefly analysed. We conclude with reflections on the future of public healthcare in South Europe.     

Chile's Criminal Law Reform: Enhancing Defendants' Rights and Citizen Security

Many democratic governments in Latin America have implemented broad judicial reforms, some of which are aimed at making criminal law and legal institutions more transparent and modern. Although such reforms are important for democratic development, scholars debate whether the reforms result in more rights for defendants and whether they jeopardize citizens' perceptions about security. Using two original datasets and a fixed‐effects model, this study shows that groundbreaking criminal law reforms in Chile have improved certain aspects of defendants' rights by decreasing the number of individuals in pretrial detention. Chileans' perceptions about crime and violence in regions where the reforms were implemented also have improved. Chile's success appears to be due to the government's commitment to the reforms, as well as to concerted and consistent efforts by the police to fight crime. These results have implications for other countries implementing similar significant reforms.     

New public management and the Thatcher healthcare legacy: enough of the theory, what about the implementation?

Initial evaluations of Thatcherism suggest that it represented a policy formulation success but implementation failure (Marsh and Rhodes 1992), with healthcare reforms particularly unsuccessful because they did not challenge the autonomy of the medical profession (Wistow 1992a and 1992b). More extensive analyses of the implementation of new public management (NPM) within health care take this challenge more seriously. According to Ferlie et al. (1996), doctors were gainers and losers, since the rise of the management function coincided with a rise in medical involvement in management decisions. However, this article argues that the rise of the purchasing function of health authorities undermined this 'gain' to the medical profession. Further, the significance of the case study—AIDS policy in Scotland—is that profound change has occurred in a policy area in which one would least expect this to happen.     

Uneasy Partners Against Crime: The Ambivalent Relationship Between the Police and the Private Security Industry in Mexico

Legitimation is a fraught process for private security companies operating in Mexico and other countries in the Global South where the police have a poor reputation. Mexican private security companies have an ambivalent relationship with the police, which causes firms to engage in two seemingly contradictory practices. Companies attempt to gain legitimacy by aligning with the image of the police to earn a sense of “symbolic stateness” while simultaneously distancing themselves from Mexico's actual police forces so as to disassociate from the institution's poor reputation. Consequently, collaboration between public and private security is limited, despite official attempts by the Mexican state to foster positive contact between them. Overall, this study contributes to the growing literature on private security by providing novel insights into the strategies private security firms utilize to navigate within states possessing delegitimated security forces, and the resulting lucrative political economy landscape.     

Excluded from Health? Informal Workers’ Access to Health Care in Chile

The Pan American Health Organisation recently highlighted the increased exclusion of low income households in Latin America from health care. The rise in informal employment and sub‐contracting of workers means that many employees lack formal contracts and are excluded from health insurance programmes. Feminist research suggests low income women are often most at risk of exclusion. Simultaneously, deeply entrenched inequalities within health systems across the region have not been addressed by health sector reforms. Drawing on the case of Chile, this paper examines the extent to which informal workers have indeed been excluded and how far these processes are gendered.     

马克思主义公有制理论与新时代中国社会主义公有制的新形式

马克思、恩格斯后来大大拓展了《共产党宣言》中的公有制理论,他们不仅寄希望于工人在必要时用暴力夺取国家政权,也寄希望于发达国家的工人用和平手段达到自己的目的,并认为在发达国家"旧社会可能和平地长入新社会"。他们注重经过社会所有制达到共产主义。在《资本论》中,马克思提出"重新建立个人所有制"的设想,认为资本主义将被自己内部的社会主义因素自我否定,社会主义公有制由此而产生。当前中国的一种新的公有制形式正在蓬勃发展,民营企业中许多股份制企业表现出新公有制特征,它们不仅率先实行现代企业制度,且职工人人持股。它们对生产资料占有方式和对企业利润的分配基本公正,职工的劳动价值得到体现。随着改革的深化、市场经济的健全,更多的新公有制企业将会成长起来。同时,广大农民随着产权的改革与落实,会在新的合作过程中建立新的公有制。新时代,新公有制与社会主义有着广阔前景。     

The Final Frontiers of Healthcare Universalisation in Costa Rica and Panama

This article explains how Costa Rica and Panama, two Central American countries with nearly universal public healthcare programmes, have come to enjoy such broad coverage. It then describes the distinct paths each is taking towards reaching the populations still left out of healthcare coverage. Costa Rica is seeking to bring all residents under the umbrella of its ILO‐style social security plan. Panama is targeting the rural poor with a package of defined interventions aimed at maternal and child mortality. The article frames these cases within the literature on the varieties of universalism.     

Las élites neoliberales en México: ¿cómo se construye un campo de poder que transforma las prácticas sociales de las élites políticas?

The recomposition of Mexican political elites during the 1980s overlaps with the transformation of a development model that shifted from a basically protectionist and nationalistic model to a neo-liberal and open-oriented one. Such a switch has implied far-reaching changes in the social practices of political elites. Based on a record that contains each high-rank official during the 1988–2014 period, the mechanisms having established a transnational power network crossing from one presidential term to the next are reviewed, as well as those factors that favored the organization of a power field increasingly focused on the border between the national, regional and global spaces. Some of those mechanisms include the international historical context; the creation of working teams with a basically neo-liberal worldview; the trajectories of the high-rank officers; the reforms that have been driven; the fluent transit among public and private positions, and the highly varied relationships established between this group of officials and transnational actors and organizations. It is concluded that the elites’ new social practices do not only hamper and challenge the creation of public goods and autonomous structures with the capacity of planning according to the general interest, but they also encourage institutional depredation.     

Reassessing South European Pensions after the Crisis: Evidence from Two Decades of Reforms

The article studies pension reforms in Greece, Italy, Portugal, and Spain between 1990 and 2013, focusing on three dimensions of change: multi-pillarisation, institutional harmonisation, and spending trends (cost-containment/expansion). The pension evolution of these countries is reassessed throughout the period of crisis and austerity. All countries encouraged the spread of private pensions and harmonised their fragmented public schemes. Cost containment was massive, putting future adequacy at risk. While international actors, especially the European Union, acquired a stronger role, that of organised labour declined. Spiralling between crisis and austerity, these systems changed and adapted, but still face old and new problems: inequality, risk individualisation, and increasing vulnerability to external shocks.     

Judging the Judiciary: Understanding Public Confidence in Latin American Courts

Although there is a substantial literature examining public confidence in the judiciary in developed nations, scholars have paid scant attention to analyzing judicial confidence in developing countries. Building on extant work regarding developed nations and introducing original hypotheses in the context of developing nations, this research explains influences on public confidence in Latin American judiciaries by developing a theory that focuses on the potential influences of institutional quality, experiences, and individual attitudes. The hypotheses are empirically tested with the rich individual‐level data compiled by the Latin American Public Opinion Project 2006 survey. The results indicate that a variety of factors influence public confidence in Latin American courts; the role of context explains points of consistency and divergence with research on developed nations.     

Postretrenchment Politics: Policy Feedback in Chile's Health and Pension Reforms

Through a comparison of three periods of health and pension reform in Chile, this article develops an explanation for the incremental form of social policy change that some Latin American nations have witnessed in recent years, despite the dramatic rise of left governments. It describes “postretrenchment politics,” which constitutes a realignment in the way politics plays out in countries that have undergone social policy retrenchment. In postretrenchment politics, the strengthened position of private business interests, combined with political learning legacies and lock‐in effects generated by reforms, results in incremental political change, despite renewed efforts by left parties to address inequality. Global capital also plays an important contextual role, and may influence postretrenchment politics. In postretrenchment politics, newly reformed systems may achieve greater equity, but they do so in fragmented form.     

Dangerous Liaisons? State-Chaebol Co-operation and the Global Privatisation of Development

This article analyses the relationships between private and public sectors in shaping the South Korean development assistance agenda. Since 2008, subsequent Korean administrations have made development assistance a keystone of their foreign policy. Fast growing middle-income countries seem to be favourite development partners for these administrations and the parallel increase in the overseas expansion of Korean chaebol in these developing partner markets suggests that interactions between private economic interests and development assistance exigencies have been numerous. Based upon fieldwork on Korean development assistance, this article shows that Korean conglomerates are both informally and structurally included in decision-making processes as a result of the specific governance architecture inherited from the developmental state era. But recently, since its accession to the Development Assistance Committee in 2010, Korea has also been institutionalising private actors’ inclusion in official development assistance delivery mechanisms. This should be understood as part of a global agenda that has increasingly privatised development formulation and delivery. The inclusion of chaebol in official development assistance through institutional mechanisms might actually be more aligned with Organisation for Economic Co-operation and Development norms than the existing literature suggests.     

Criminal Violence and Democratization in Central America: The Survival of the Violent State

Why does Nicaragua have less violent crime than Guatemala, El Salvador, and Honduras? All these countries underwent political transitions in the 1990s. Many explanations point to the legacies of war, socioeconomic underdevelopment, and neoliberal structural reforms. However, these arguments do not fully explain why, despite economic reforms conducted throughout the region, war‐less Honduras and wealthier Guatemala and El Salvador have much more crime than Nicaragua. This article argues that public security reforms carried out during the political transitions shaped the ability of the new regimes to control the violence produced by their own institutions and collaborators. In the analysis of the crisis of public security, it is important to bring the state back. The survival of violent entrepreneurs in the new security apparatus and their relationship with new governing elites foster the conditions for the escalation of violence in northern Central America.     

The Economy of China

Evidence suggests that following liberalisation reforms in India, public sector contributions to social development projects responsible for public goods allocation and the provision of services have receded in favour of an enlarged role for private sector initiatives, particularly through public-private partnerships. As part of a “good governance” agenda, the state is embracing such partnerships, modelled on information communication technology (ICT), within a wider development strategy (ICTD) to improve goods allocation and government's image as a trustworthy agent. This has also coincided with a changing political economy that has granted greater authority to more localised units of government over economic and developmental processes. This paper examines a case study of Urban e-Seva, an ICTD public-private partnership in Hyderabad, and couches it in a larger examination of contemporary social development in India. The paper concludes that government needs to be embedded in public-private partnerships, that it must continue to be at the forefront of allocation strategies in general, and that globalisation is strongly shaped by public institutions operating at the sub-national level. Furthermore, reforms are needed to correct for globalisation and liberalisation's inabilities to foster proper social development in India.     

Welfare States Facing HIV/AIDS. Organizational Responses in Western Europe (1981–91)

In this article the author analyzes comparatively several organizational models which were introduced in a dozen West European countries to address the problem of HIV/AIDS. Analyzing some aspects of the organizational design, the logic of intervention (sectorial or global), the type of actors (public or private) and the type of relations between actors, she elaborates a typology of responses. Three types are identified, presenting unexpected variants in respect to general typologies of the western welfare state. The author also notes that a form of social regulation based on private actors has been adopted in all countries under consideration. These results lead her to the hypothesis that the factors of innovation or modernization in administrations facing the management of such problems are grounded in new forms of collaboration between actors of different legal status.