Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T09:38:52.358Z Has data issue: false hasContentIssue false
  • English
  • Français

Territorial Inequality in Health Service Delivery: Lessons from Latin America’s Federations

Published online by Cambridge University Press:  29 June 2020

Agustina Giraudy Open the ORCID record for Agustina Giraudy [Opens in a new window]  and
Jennifer Pribble Open the ORCID record for Jennifer Pribble [Opens in a new window]
Agustina Giraudy*
Affiliation:
Agustina Giraudy is an associate professor in the School of International Service, American University.
Jennifer Pribble*
Affiliation:
Jennifer Pribble is an associate professor of political science and global studies at the University of Richmond.
*
[email protected].
[email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Access to quality healthcare varies across the national territory inside Latin American countries, with some subnational units enjoying higher-quality care than others. Such territorial inequality is consequential, as residents of particular regions face shorter life spans and an increased risk of preventable disease. This article analyzes trajectories of territorial healthcare inequality across time in Argentina, Brazil, and Mexico. The data reveal a large decline in Brazil, a moderate decline in Mexico, and low levels of change followed by a moderate decline in Argentina. The article argues that two factors account for these distinct trajectories: the nature of the coalition that pushed health decentralization forward and the existence of mechanisms for central government oversight and management.

Keywords

Territorial inequalityhealthcareinfant mortalitydecentralization
Type
Research Article
Information
Latin American Politics and Society , Volume 62 , Special Issue 3: The Subnational State in Latin America , August 2020 , pp. 19 - 43
Copyright
© University of Miami 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflict of interest: Agustina Giraudy and Jennifer Pribble declare none.

References

Akin, John, Hutchinson, Paul, and Strumpf, Koleman. 2007. Decentralisation and Government Provision of Public Goods: The Public Health Sector in Uganda. Journal of Development Studies 41, 8: 1417–43.CrossRefGoogle Scholar
Alves, Jorge Antonio. 2015. (Un?)Healthy Politics: The Political Determinants of Subnational Health Systems in Brazil. Latin American Politics and Society 57, 4: 119–42.CrossRefGoogle Scholar
Alday, Arjonilla, Sofía. 2006. Guanajuato: Invisible Results. In Homedes and Ugalde 2006b. 209.Google Scholar
Urdaneta, Avila, Maritza. 2010. La salud en el paradigma de la descentralización en América Latina. Revista de Ciencias Sociales 16, 3: 526–43.Google Scholar
Bardhan, Pranab, and Mookherjee, Dillip. 2006. Decentralisation and Accountability in Infrastructure Delivery in Developing Countries. Economic Journal 116, 508: 101–27.CrossRefGoogle Scholar
Barrientos, Armando. 2002. Health Policy in Chile: The Return of the Public Sector? Bulletin of Latin American Research 21, 3: 442–59.CrossRefGoogle Scholar
Birn, Anne Emanuelle. 2006. Federalist Flirtations: The Politics and Execution of Health Services Decentralization for the Uninsured Population in Mexico, 1985–1995. In Homedes and Ugalde 2006b. 123.Google Scholar
Bisang, Roberto, and Cetrángolo, Oscar. 1997. Descentralización de los servicios de salud en la Argentina. Serie Reformas de política pública. Santiago: Comisión Económica para América Latina y el Caribe.Google Scholar
Bonvecchi, Alejandro, and Lodola, Germán. 2011. The Dual Logic of Intergovernmental Transfers: Presidents, Governors, and the Politics of Coalition-Building in Argentina. Publius: The Journal of Federalism 41, 2: 179–206.CrossRefGoogle Scholar
Brieba, Daniel. 2018. State Capacity and Health Outcomes: Comparing Argentina’s and Chile’s Reduction of Infant and Maternal Mortality, 1960–2013. World Development 101 (January): 37–53.CrossRefGoogle Scholar
Caldwell, Kia Lilly. 2017. Health Equity in Brazil: Intersections of Gender, Race, and Policy. Urbana: University of Illinois Press.CrossRefGoogle Scholar
Myriam, Cardozo Brum. 1993. La descentralización de los servicios de salud en México: hacia la amnesia total o hacia la recuperación de la política. Gestión y Política Pública 2 (July– December): 365–91.Google Scholar
Collins, Charles, Araujo, José, and Jarbas, Barbosa. 2000. Decentralizing the Health Sector: Issues in Brazil. Health Policy 52, 2: 113–27.CrossRefGoogle Scholar
Colluci, Cláudia. 2018. Brazil’s Child and Maternal Mortality Have Increased Against Background of Public Spending Cuts. BMJ 362: k3583. https://www.bmj.com/content/362/bmj.k3583CrossRefGoogle Scholar
Crook, Richard C., and Alan Sturla Sverrisson. 1999. To What Extent Can Decentralised Forms of Government Enhance the Development of Pro-Poor Policies and Improve Poverty-Alleviation Outcomes? Working paper. Washington, DC: World Bank.Google Scholar
De la, O, Lorena, Ana. 2015. Crafting Policies to End Poverty in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Eaton, Kent. 2004. Risky Business: Decentralization from Above in Chile and Uruguay. Comparative Politics 37, 1: 1–22.CrossRefGoogle Scholar
Eaton, Kent. 2020. Latin American Politics and the Subnational Comparative Method: Vertical and Horizontal Challenges. This issue.CrossRefGoogle Scholar
Eskeland, Gunnar S., and Filmer, Deon. 2002. Autonomy, Participation, and Learning in Argentine Schools: Findings and Their Implications for Decentralization. Policy Research Working Paper. Washington DC: World Bank.Google Scholar
Ewig, Christina. 2016. Reform and Electoral Competition: Convergence Toward Equity in Latin American Health Sectors. Comparative Political Studies 49, 2: 184–218.CrossRefGoogle Scholar
Falleti, Tulia G. 2010. Decentralization and Subnational Politics in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Faguet, Jean-Paul. 2013. Decentralization and Popular Democracy: Governance from Below in Bolivia. Ann Arbor: University of Michigan Press.Google Scholar
Filgueira, Fernando, Carlos Gerardo Molina, Papadópulos, Jorge, and Tobar, Federico. 2006. Universalismo básico: una alternativa posible y necesaria para mejorar las condiciones de vida. In Universalismo básico: una nueva política social para América Latina, ed. Molina. Washington, DC: Inter-American Development Bank.Google Scholar
Finot, Iván. 2002. Descentralización y participación en América Latina: una mirada desde la economía. Revista de la CEPAL 78: 139–49.CrossRefGoogle Scholar
Friedmann, Santiago, Lustig, Nora, and Legovini, Arianna. 1995. Mexico: Social Spending and Food Subsidies During Adjustment in the 1980s. In Coping with Austerity: Poverty and Inequality in Latin America, ed. Lustig. Washington, DC: Brookings Institution Press. 334–74.Google Scholar
Galiani, Sebastian, Gertler, Paul, and Schargrodsky, Ernesto. 2008. School Decentralization: Helping the Good Get Better, But Leaving the Poor Behind. Journal of Public Economics 92, 10–11: 2106–20.CrossRefGoogle Scholar
Garay, Candelaria. 2016. Social Policy Expansion in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Gibson, Christopher. 2017. The Consequences of Movement Office-Holding for Health Policy Implementation and Social Development in Urban Brazil. Social Forces 96, 2: 751–78.CrossRefGoogle Scholar
Gibson, Christopher. 2019. Movement-Driven Development: The Politics of Health and Democracy in Brazil. Stanford: Stanford University Press.CrossRefGoogle Scholar
Giraudy, Agustina, and Pribble, Jennifer. 2019. Rethinking Measures of Democracy and Welfare State Universalism: Lessons from Subnational Research. Regional and Federal Studies 29, 2: 135–63.CrossRefGoogle Scholar
Giraudy, Agustina, Moncada, Eduardo, and Snyder, Richard, eds. 2019. Subnational Research in Comparative Politics. New York: Cambridge University Press.CrossRefGoogle Scholar
de México, Gobierno. Consejo Nacional de Población (CONAPO). 2017. Indicadores demográficos básicos. http://www.conapo.gob.mx/work/models/CONAPO/Mapa_ Ind_Dem18/index_2.htmlGoogle Scholar
de México, Gobierno. de Salud, Secretaría. 2015a. Carta de derechos y obligaciones 2015, para los afiliados al “Seguro Popular.” Mexico City: Secretaría de Salud. www.gob.mx/ saludGoogle Scholar
de México, Gobierno. 2015b. Boletín de Información Estadística 2014–2015.Google Scholar
Charles, Griffin. 1999. Empowering Mayors, Hospital Directors, or Patients? The Decentralization of Health Care. In Beyond the Center: Decentralizing the State, ed. Shahid Javed Burki, Guillermo E. Perry, and William R. Dillinger. Washington, DC: World Bank. 75–86.Google Scholar
Habibi, Nadir, Huang, Cindy, Miranda, Diego, Murillo, María, Ranis, Gustav, Sarkar, Mainak, and Stewart, Frances. 2003. Decentralization and Human Development in Argentina. Journal of Human Development and Capabilities 4, 1: 73–101.CrossRefGoogle Scholar
Harbers, Imke, and Steele, Abbey. 2020. Introduction: Subnational Variation Across States: A Typology and Research Agenda. This issue.CrossRefGoogle Scholar
Hernández, Mario. 2002. Reforma sanitaria, equidad y derecho a la salud en Colombia. Cadernos de Saúde Pública 18, 4: 991–1001.CrossRefGoogle Scholar
Homedes, Núria, and Ugalde, Antonio. 2006a. Decentralization of Health Services in Mexico: A Historical Review. In Homedes and Ugalde 2006b. 45–91.Google Scholar
Homedes, Núria, and Ugalde, Antonio, eds. 2006b. Decentralizing Health Services in Mexico: A Case Study in State Reform. La Jolla: Center for U.S.-Mexican Studies, University of California, San Diego.Google Scholar
Huber, Evelyne, and John, D. Stephens. 2012. Democracy and the Left: Social Policy and Inequality in Latin America. Chicago: University of Chicago Press.CrossRefGoogle Scholar
Lakin, Jason. 2010. The End of Insurance? Mexico’s Seguro Popular, 2001–2007. Journal of Health Politics, Policy, and Law 35, 3: 313–52.CrossRefGoogle Scholar
Langer, Ana, José, Luis Bobadilla, and Juan, Schlaepfer Pedrazzini. 1990. Limitaciones de la mortalidad infantil como indicador de salud. Salud Pública Mexicana 32, 4: 467–73.Google Scholar
Liu, Korbin, Moon, Marilyn, Sulvetta, Margaret, and Chawla, Juhi. 1992. International Infant Mortality Rankings: A Look Behind the Numbers. Health Care Financing Review 13, 3: 105–18.Google Scholar
Lloyd-Sherlock, Peter. 2004. Ambitious Plans, Modest Outcomes: The Politics of Health Care Reform in Argentina. InCrucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America, ed. Kaufman, Robert and Joan, M. Nelson.Baltimore: Johns Hopkins University Press. 93–123.Google Scholar
López-Calva, Luis Felipe, and Nora, Claudia Lustig, eds. 2010. Declining Inequality in Latin America: A Decade of Progress. Washington, DC: Brookings Institution Press.Google Scholar
Manatt Jones Global Strategies. 2015. Mexican Healthcare System Challenges and Opportunities. Report. https://pdfs.semanticscholar.orgGoogle Scholar
Franzoni, Martínez, Juliana, and Diego Sánchez Ancochea. 2016. The Quest for Universal Social Policy in the South. New York: Cambridge University Press.CrossRefGoogle Scholar
McGuire, James. 2010a. Political Factors and Health Outcomes: Insight from Argentina’s Provinces. Human development research paper. United Nations Human Development Program. http://hdr.undp.org/sites/default/files/hdrp_2010_25.pdfGoogle Scholar
McGuire, James. 2010b. Wealth, Health and Democracy in East Asia and Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
McGuire, James. 2017. Database of Social, Economic, and Political Indicators of Argentine Provinces.Google Scholar
Niedzwiecki, Sara. 2018a. Brazilian StateIndicators. University of California, Santa Cruz. https://www.saraniedzwiecki.com/uneven-social-policies.htmlGoogle Scholar
Niedzwiecki, Sara. 2018b. Uneven Social Policies: The Politics of Subnational Variation in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Niedzwiecki, Sara, and Anria, Santiago. 2019. Participatory Social Policies: Diverging Patterns in Brazil and Bolivia. Latin American Politics and Society 61, 2: 115–37.CrossRefGoogle Scholar
Santana, Olvera, Lucila. 2006. “Decentralized” in Quotes: Baja California Sur, 1996–2000. In Homedes and Ugalde 2006b. 153.Google Scholar
Osterkatz, Sandra Chapman. 2011. Capacity and Commitment: How Decentralization in Brazil Impacts Health Policy. Paper presented at the Congress of the American Political Science Association, Seattle, September 1–4.Google Scholar
Osterkatz, Sandra Chapman. 2013. Commitment, Capacity, and Community: The Politics of Multi-Level Health Reform in Spain and Brazil. Ph.D. diss., Department of Political Science, University of North Carolina, Chapel Hill.Google Scholar
Otero-Bahamón, Silvia. 2016. When the State Minds the Gap: The Politics of Subnational Inequality in Latin America. Ph.D. diss., Northwestern University.Google Scholar
Otero-Bahamón, Silvia. 2019. Subnational Inequality in Latin America: Empirical and Theoretical Implications of Moving Beyond Interpersonal Inequality. Studies in Comparative International Development 54: 185–209.CrossRefGoogle Scholar
Pirious-Sall, Suzanne. 1998. Decentralization and Rural Development: A Review of Evidence. Washington, DC: World Bank.Google Scholar
Pribble, Jennifer. 2013. Welfare and Party Politics in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Reidpath, Daniel D., and Allotey, Pascale. 2003. Infant Mortality Rate As an Indicator of Population Health. Journal of Epidemiology and Community Health 57, 5: 344–46.CrossRefGoogle Scholar
Rodrigues-Silveira, Rodrigo. 2011. Descentralización y focalización del gasto social en los municipios brasileños. Latin American Research Review 46, 3: 69–92.CrossRefGoogle Scholar
Rodrigues-Silveira, Rodrigo. 2019. Public Policy Provision from a Subnational Perspective: Context, Institutions and Spatial Inequality. Regional and Federal Studies 29, 2: 275–94.CrossRefGoogle Scholar
Ross, Michael. 2006. Is Democracy Good for the Poor? American Journal of Political Science 50, 4: 860–74.CrossRefGoogle Scholar
Rubenstein, Adolfo, María, Clara Zerbino, Cejas, Cintia, and López, Analía. 2018. Making Universal Health Care Effective in Argentina: A Blueprint for Reform. Health Systems and Reform 4, 3: 203–13.CrossRefGoogle Scholar
Solnick, Steven Lee. 1996. The Breakdown of Hierarchies in the Soviet Union and China. World Politics 48, 2: 209–38.CrossRefGoogle Scholar
Spangler, Sydney. 2012. Assessing Skilled Birth Attendants and Emergency Obstetric Care in Rural Tanzania: The Inadequacy of Using Global Standards and Indicators to Measure Local Realities. Reproductive Health Matters 20, 39: 133–41.CrossRefGoogle Scholar
Sugiyama, Natasha Borges. 2012. Diffusion of Good Government: Social Sector Reforms in Brazil. Notre Dame: Notre Dame University Press.CrossRefGoogle Scholar
Touchton, Michael, and Wampler, Brian. 2014. Improving Social Well-Being Through New Democratic Institutions. Comparative Political Studies 47, 10: 1442–69.CrossRefGoogle Scholar
Touchton, Michael, Natasha, Borges Sugiyama, and Wampler, Brian. 2017. Democracy at Work: Moving Beyond Elections to Improve Well-Being. American Political Science Review 111, 1: 68–82.CrossRefGoogle Scholar
Ugalde, Antonio, and Homedes, Núria. 2006. Decentralization: The Long Road from Theory to Practice. In Homedes and Ugalde 2006b.Google Scholar
Leyer, Velázquez, Ricardo, and Juan Pablo Ferrero. 2016. Social Policy Expansion, Democracy and Social Mobilization in Latin America: Healthcare Reform in Brazil and Mexico. Journal of Iberian and Latin American Research 22, 2: 117–34.CrossRefGoogle Scholar
Wampler, Brian, Natasha Borges Sugiyama, and Touchton, Michael. 2019. Democracy at Work: Pathways to Well-being in Brazil. New York: Cambridge University Press.CrossRefGoogle Scholar
Zylbersztejn, Ania, Gilbert, Ruth, Hjern, Anders, and Hardelid, Pia. 2017. How Can We Make International Comparisons of Infant Mortality in High Income Countries Based on Aggregate Data More Relevant to Policy? BMC Pregnancy and Childbirth 17, article no. 430: 1–7.Google Scholar