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Contradictions and Constraints in Chile's Health Care and Education Decentralization

Published online by Cambridge University Press:  02 January 2018

Mary Rose Kubal
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Abstract

Proponents of social service decentralization often claim that transferring service administration to lower levels of government facilitates increases citizen participation and governmental accountability while improving allocative efficiency and equity in service distribution. Using the cases of health and education decentralization in Chile, this article evaluates whether and under what conditions social service decentralization programs are likely to deliver on these promises. It discusses the tensions between equity and efficiency goals and how these may play out given different accountability mechanisms in local public choice, principal-agent, and real-world “hybrid” decentralization models. The case studies illustrate the difficulty of balancing the need for central standards and funding with local autonomy, but suggest that accountability mechanisms that emerged following Chile's transition to democracy in 1990 led to improvements in both equity and efficiency in decentralized service administration.

Type
Research Article
Information
Latin American Politics and Society , Volume 48 , Issue 4 , Winter 2006 , pp. 105 - 135
Copyright
Copyright © University of Miami 2006

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References

Agrawal, Arun, and Jesse, Ribot. 1999. Accountability and Decentralization: a Framework with South Asian and West African Cases. Journal of Developing Areas 33: 473–502.Google Scholar
Allard, Raul. 1994. La decentralización educational en el período de transición. Serie Estudios Municipales, no. 3. Santiago: Corporación de Promoción Universitaria (Cpu).Google Scholar
Belmar, Jaime. 2003. Executive Secretary, AchM. Author interview. Santiago, June 26.Google Scholar
Bennett, Robert J. 1990. Decentralization, Intergovernmental Relations and Markets: Towards a Post-Welfare Agenda? In Decentralization, Local Governments, and Markets, ed. Bennett, Oxford: Clarendon. 1–26.Google Scholar
Brown, David S. 1999. Reading, Writing, and Regime Type: Democracy's Impact on Primary School Enrollment. Political Research Quarterly 54, 4: 1–707.Google Scholar
Brown, David S., and Wendy, Hunter. 1999. Democracy and Social Spending in Latin America, 1980–92. American Political Science Review 93, 4: 1–90.CrossRefGoogle Scholar
Carciofi, Ricardo, Oscar, Centrangolo, and Osvaldo, Larrañaga 1996. Desafíos de la descentralización: educación y salud en Argentina y Chile. Santiago: CEPAL.Google Scholar
Colegio de Profesores Chile. 2002. Financiamiento de la educación en Chile. Santiago: Cenda. <http://cep.clCendaProyectosColegio_ProfesoresFinanciamiento_EducacionInformesInforme_0204Financiamiento_Educacion.html>..>Google Scholar
Collins, Joseph, and John, Lear. 1995. Chile's Free Market Miracle: A Second Look. Oakland: Food First.Google Scholar
Cornejo, Gonzalo. 2003. Mayor, Recoleta. Author interview. Recoleta (Santiago), July 10.Google Scholar
Courard, Hernán. 1998. Dinámicas recientes de participación en el ámbito educacional en Chile. In Nociones de una ciudadanía que crece, ed. Enrique, Correa. and Marcela, Noe. Santiago: FLACSO. 1–76.Google Scholar
Delannoy, François. 2000. Education Reforms in Chile, 1980–98: a Lesson in Pragmatism. World Bank Country Studies, Education and Management Publication Series. <http://www1.worldbank.orgeducationglobaleducationreformpdfdelannoy.pdf>..>Google Scholar
Duarte, Dagoberto. 1993. Asignación de recursos financieros al sector municipalizado de salud. Papeles de Trabajo, Programa de Estudios Prospectivos (PEP). Santiago: Corporación Tiempo 2000.Google Scholar
Duarte, Dagoberto. 1995. El sector de salud municipalizado: elementos de análysis y propuestas de transformación. Serie Estudios Municipales Santiago: CPU.Google Scholar
Eaton, Kent. 2001. Political Obstacles to Decentralization: Evidence from Argentina and the Philippines. Development and Change 32: 101–27.CrossRefGoogle Scholar
Eaton, Kent. 2004. Designing Subnational Institutions: Regional and Municipal Reforms in Postauthoritarian Chile. Comparative Political Studies 37, 2: 1–87.CrossRefGoogle Scholar
Frank, Volker. 2002. The Elusive Goal in Democratic Chile: Reforming the Pinochet Labor Legislation. Latin American Politics and Society 44, 1: 1–68.CrossRefGoogle Scholar
Friedmann, Reinhard. 1995. Análysis institucional del sistema de salud chileno. In El sistema de salud en Chile ante la descentralización política. Santiago: ILPES.Google Scholar
Garman, Christopher, Stephan, Haggard, and Eliza, Willis. 2001. Fiscal Decentralization: a Political Theory with Latin American Cases. World Politics 53: 205–36.CrossRefGoogle Scholar
Garretón, Manuel Antonio. 1994. The Political Dimension of Processes of Transformation in Chile. In Democracy, Markets, and Structural Reforms in Latin America, ed. William, C. Smith, Carlos, Acuña, and Eduardo, Gamarra. New Brunswick: Transaction.Google Scholar
Gauri, Varun. 1998. School Choice in Chile. Pittsburgh: University of Pittsburgh Press.Google Scholar
Gershberg, Alec. 1999. Education “Decentralization” Processes in Mexico and Nicaragua: Legislative versus Ministry-Led Reform Strategies. Comparative Education 35, 1: 1–81.CrossRefGoogle Scholar
Gideon, Jasmine. 2001. The Decentralization of Primary Health Care Delivery in Chile. Public Administration and Development 21: 223–31.CrossRefGoogle Scholar
Gorostiaga Derqui, Jorge M. 2001. Educational Decentralization Policies in Argentina and Brazil: Exploring the New Trends. Journal of Education Policy 16, 6: 1–83.Google Scholar
Graham, Carol. 1998. Private Markets for Public Goods. Washington, DC: Brookings Institution Press.Google Scholar
Herrera, Carlos. 1997. Functionary, Ministry of Education, General Education Division, Supervisory Unit. Author interview. Santiago, November 4.Google Scholar
Hershberg, Eric. 1997. Market-Oriented Development Strategies and State-Society Relations in New Democracies: Lessons from Contemporary Chile and Spain. In The New Politics of Inequality in Latin America, ed. Douglas, A. Chalmers. et al. Oxford: Oxford University Press. 1–59.Google Scholar
Heyermann Gajardo, Beatriz. 1994. Municipio, descentralización y salud. Seminario sobre “Municipalización de los Servicios Sociales” Doc. Trabajo no. 1. Santiago: ILPES/CEPAL.Google Scholar
Huber, Evelyne, Tom, Mustillo, and John, Stephens. 2004. Determinants of Social Spending in Latin America. Paper presented at the meetings of the Society for the Advancement of Socio-Economics, Washington, DC, July 1–11.Google Scholar
Inter-American Development Bank (IDB).. 1994. Economic and Social Progress in Latin America. Washington, DC: Johns Hopkins University Press.Google Scholar
Jiménez de la Jara, Jorge, and Thomas, Bossert. 1995. Chile's Health Sector Reform: Lessons from Four Reform Periods. Health Policy 32: 155–66.CrossRefGoogle Scholar
Kaufman, Robert R., and Alex, Segura. 2001. Globalization, Domestic Politics, and Social Spending in Latin America: a Time-Series Cross-Section Analysis, 1973–97. World Politics 53: 553–87.CrossRefGoogle Scholar
Kubal, Mary Rose. 2001. Decentralization and Citizen Participation in Urban Chile: the Transfer of Health and Education Administration to Local Governments. Ph.D. diss., University of North Carolina, Chapel Hill.Google Scholar
Lake, David A., and Matthew, A. Baum. 2001. The Invisible Hand of Democracy: Political Control and the Provision of Public Services. Comparative Political Studies 34, 6: 1–621.CrossRefGoogle Scholar
Litvack, Jennie, Junaid, Ahmad, and Richard, Bird. 1998. Rethinking Decentralization in Developing Countries. Washington, DC: World Bank.CrossRefGoogle Scholar
López, Murphy, Ricardo, Oscar Libonatti, and Mario, Salinardi. 1995. Overview and Comparison of Fiscal Decentralization Experiences. In Fiscal Decentralization in Latin America, ed. López, Murphy Washington, DC: Inter-American Development Bank. 1–58.Google Scholar
Luna, Monica. 1997. Acting Executive Secretary, AchM. Author interview. Santiago, June 16.Google Scholar
Manuel, Annick. 2002. The Chilean Health System: 20 Years of Reforms. Salud Pública de México 44, 1: 1–68.CrossRefGoogle ScholarPubMed
Marcel, Mario. 1994. Decentralization and Development: The Chilean Experience. In En Route to Modern Growth, ed. Gustav, Ranis. Washington, DC: IDB. 1–121.Google Scholar
Marcel, Mario. 2001. Responsabilidad fiscal: neoliberal o progresista Chile Hoy, March 3 <http://www.chile-hoy.deecon_trab050301_neoliberalismo.htm>..>Google Scholar
Mardones, Rodrigo. 2005. The Politics of Decentralization in a Centralized Polity: the Case of Chile during the Concertación's Governments. Ph.D. diss., New York University.Google Scholar
Martínez, Javier, and Alvaro, Díaz 1996. Chile, The Great Transformation. Washington, DC: Brookings Institution Press.Google Scholar
Melo, Sady. 1997. Mayor, El Bosque. Author interview. El Bosque (Santiago), November 7.Google Scholar
El Mercurio (Santiago) 1997a. Chile, the Great Transformation. May 12.Google Scholar
El Mercurio 1997b. Chile, the Great Transformation. May 16.Google Scholar
El Mercurio 1997c. Chile, the Great Transformation. September 30.Google Scholar
Ministerio de Educación.. 1996. La reforma educativa en marcha. Gestión de la Educación Municipal. Santiago: CPU. 1–75.Google Scholar
Ministerio de Educación.. 2001. Simce: Resultados 2001. <http://www.simce.cldoccomunicado_prensa.pdf>..>Google Scholar
Ministerio de Educación. n.d. Guía metodológica: formulación del plan anual de desarrollo educativo municipal, Padem.Google Scholar
Ministerio de Interior (SUBDERE).. 1992. Manual de Gestión Municipal.Google Scholar
Ministerio de Planificación y Cooperación (Mideplan). n.d. Indicadores económicos y sociales: 1990–2000 <http://www.mideplan.clsitioSitioindicadoreshtmindicadores_econ1999_2000.htm>..>Google Scholar
Molina, Germán. 1997. Education Representative, AchM. Author interview. El Bosque (Santiago), June, 19.Google Scholar
Montt, Pedro, and Pedro, Serra. 1994. La descentralización educativa en Chile: el traspaso de la educación a los municipios. Seminario sobre “Municipalización de los Servicios Sociales,” Doc. Trabajo no. 3. Santiago: ILPES/CEPAL.Google Scholar
Mostajo, Rossana. 2000. Gasto social y distribución del ingreso: caracterización e impacto redistributivo en países seleccionados de América Latina y El Caribe. Serie Reformas Económicas 69. Santiago: CEPAL.Google Scholar
Murillo, María Victoria. 1999. Recovering Political Dynamics: Teachers' Unions and the Decentralization of Education in Argentina and Mexico. Journal of Interamerican Studies and World Affairs 41, 1 (Spring): 1–58.CrossRefGoogle Scholar
Nickson, R. Andrew. 1995. Local Government in Latin America. Boulder: Lynne Rienner.CrossRefGoogle Scholar
Noticias AchM 2002. Escolaridad obligatoria y subvención diferenciada dio a conocer a la AchM, Ministra de Educación. Santiago: Asociación Chilena de Municipalidades. October 8.Google Scholar
O'Donnell, Guillermo. 1996. Illusions about Consolidation. Journal of Democracy 7, 2: 1–51.CrossRefGoogle Scholar
O'Neill, Kathleen. 2003. Decentralization as an Electoral Strategy. Comparative Political Studies 36, 9: 1–91.CrossRefGoogle Scholar
Oxhorn, Philip. 1995. Organizing Civil Society: The Popular Sectors and the Struggle for Democracy in Chile. University Park: Pennsylvania State University Press.Google Scholar
Parry, Taryn Rounds. 1997. Decentralization and Privatization: Education Policy in Chile. Journal of Public Policy 17: 107–33.CrossRefGoogle Scholar
Peterson, George E. 1997. Decentralization in Latin America: Learning Through Experience. Washington, DC: World Bank.CrossRefGoogle Scholar
Prud'homme, Remy. 1995. The Dangers of Decentralization. World Bank Research Observer 10, 2: 1–20.CrossRefGoogle Scholar
Raczynski, Dagmar, and Claudia, Serrano. 1987. Administración y gestión local: la experiencia de algunos municipios en Santiago. Colección Estudios CIEPLAN 22 (December): 1–51.Google Scholar
Ramírez, María José, and Gabriel, Zuñiga 1997. Evaluación de los proyectos de mejoramiento de la gestión municipal en educación. Santiago: Ministerio del Interior.Google Scholar
Roberts, Kenneth M. 1998. Deepening Democracy?The Modern Left and Social Movements in Chile and Peru. Stanford: Stanford University Press.Google Scholar
Rondinelli, Dennis. 1989. Decentralizing Public Services in Developing Countries. Journal of Social Political and Economic Studies 14: 77–98.Google Scholar
Samoff, Joel. 1990. Decentralization: the Politics of Interventionism. Development and Change 21: 513–30.CrossRefGoogle Scholar
Samuels, David. 2000. Reinventing Local Government?Municipalities and Intergovernmental Relations in Democratic Brazil. In Democratic Brazil, ed. Peter, Kingstone. and Timothy, J. Pittsburgh: University of Pittsburgh Press. 1–110.Google Scholar
Santiago times online 1997. November 28. <http://www.tcgnews.comsantiagotimes>..>Google Scholar
Santiago times online 2000a. March 13.Google Scholar
Santiago times online 2000b. April 10.Google Scholar
Santiago times online 2000c. June 9.Google Scholar
Santiago times online 2000d. July 10.Google Scholar
Santiago times online 2001a. May 4.Google Scholar
Santiago times online 2001b. June 18.Google Scholar
Santiago times online 2003. May 9.Google Scholar
Santiago times online 2004. May 26.Google Scholar
Slater, David. 1989. Territorial Power and the Peripheral State: the Issue of Decentralization. Development and Change 20: 501–31.CrossRefGoogle Scholar
Tiebout, Charles. 1956. A Pure Theory of Local Expenditures. Journal of Political Economy 64: 416–24.CrossRefGoogle Scholar
Vargas, Jaime. 1997. Researcher, Centro de Investigación y Desarollo de la Educación (Cide). Author interview. Santiago, November, 12.Google Scholar
Verdugo, Angélica. Dr. 1997. Municipal Health Director, El Bosque. Author interview. El Bosque (Santiago), May 8.Google Scholar
Vergara, Marcos. 2001. La dicotomía estado-mercado del sector de la salud en Chile. Estudios Sociales 108, 2: 1–31.Google Scholar
Weyland, Kurt. 1997. “Growth with Equity” in Chile's New Democracy Latin American Research Review 32, 1: 1–67.CrossRefGoogle Scholar
Wiesner, Eduardo. 2003. Fiscal Federalism in Latin America: From Entitlements to Markets. Washington, DC: IDB.Google Scholar
Willis, Eliza, Christopher, Garman, and Stephan, Haggard. 1999. The Politics of Decentralization in Latin America. Latin American Research Review 34, 1: 1–56.CrossRefGoogle Scholar
Wolman, Harold. 1990. Decentralization: What It Is and Why We Should Care. In Decentralization, Local Governments, and Markets, ed. Robert, J. Bennett. Oxford: Clarendon. 1–42.Google Scholar
Yañez, José, and Leonardo, Letelier. 1995. Chile. In Fiscal Decentralization in Latin America, ed. Ricardo, López Murphy Washington, DC: IDB. 1–88.Google Scholar
Zambra, Fabiola. 1997. Researcher, Participa. Author interview. Santiago, October 8.Google Scholar
Zuleta, Raúl. 1997. Municipal Council Member, Peñalolen. Author interview. Peñalolen (Santiago), November 18.Google Scholar