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(Un?)Healthy Politics: The Political Determinants of Subnational Health Systems in Brazil

Published online by Cambridge University Press:  02 January 2018

Jorge Antonio Alves
Jorge Antonio Alves*
Affiliation:
Queens College, City University of New York. [email protected]
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Abstract

How does political competition shape institutions that govern the expansion of social policy subnationally? Brazilian states have shown a surprising variation in the design of their public health institutions, which regulate the distribution of health resources and citizen access to public health care. While many states have experienced fragmentation, some have remained highly centralized and discretionary, and only a select few have established a coordinated system based on power sharing and rules-based distribution. Accounts that link public health care expansion to federal government imposition, the presence of the public health care movement, and leftist parties cannot fully explain this variation. Instead, in the three Brazilian states examined here, the nature of subnational political competition triggered different institution-building strategies. The findings indicate that plural political competition yielded incentives for limiting state-level discretion and for sharing power with municipal governments, while political concentration reinforced the attraction to centralized and discretionary policymaking.

Type
Research
Information
Latin American Politics and Society , Volume 57 , Issue 4 , Winter 2015 , pp. 119 - 142
Copyright
Copyright © University of Miami 2015

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References

Abers, Rebecca Neaera. 2000. Inventing Local Democracy: Grassroots Politics in Brazil. Boulder: Lynne Rienner.Google Scholar
Abers, Rebecca Neaera, and Keck, Margaret E.. 2013. Practical Authority: Agency and Institutional Change in Brazilian Water Politics. New York: Oxford University Press.CrossRefGoogle Scholar
Abrúcio, Fernando. 1998. Os barões da federação: o poder dos governadores no Brasil pós-autoritário. São Paulo: Hucitec.Google Scholar
Alston, Lee, Melo, Marcus, Mueller, Bernardo, and Pereira, Carlos. 2008. The Predatory or Virtuous Choices Governors Make: Political Institutions and Economic Performance. www.odi.org/events/docs/2071.pdf. Accessed June 18, 2008.Google Scholar
Arretche, Marta. 2004. Toward a Unified and More Equitable Health System: Health Reform in Brazil. In Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America, ed. Kaufman, Robert R. and Nelson, Joan M.. Baltimore: Johns Hopkins University Press.Google Scholar
Arretche, Marta, and Marques, Eduardo. 2002. Municipalização da saúde no Brasil: diferenças regionais, poder de voto e estratégias de governo. Ciěncia & Saúde Coletiva 7, 3): 455–79.Google Scholar
Arvate, Paulo. 2013. Electoral Competition and Local Government Responsiveness in Brazil. World Development 43 (March): 67–83.Google Scholar
Avritzer, Leonardo. 2009. Participatory Institutions in Democratic Brazil. Baltimore: Johns Hopkins University Press.CrossRefGoogle Scholar
Baiocchi, Gianpaolo. 2005. Militants and Citizens: The Politics of Participatory Democracy in Porto Alegre. Stanford: Stanford University Press.Google Scholar
Bates, Robert. 1997. Open-Economy Politics: The Political Economy of the World Coffee Trade. Princeton: Princeton University Press.Google Scholar
Berliner, Daniel, and Erlich, Aaron. 2015. Competing for Transparency: Political Competition and Institutional Reform in Mexican States. American Political Science Review 109, 1): 110–28.CrossRefGoogle Scholar
Borges, André. 2007. Rethinking State Politics: the Withering of State Dominant Machines in Brazil. Brazilian Political Science Review 1, 2): 108–36.CrossRefGoogle Scholar
Borges, André. 2008. State Government, Political Competition and Education Reform: Comparative Lessons from Brazil. Bulletin of Latin American Research 27, 2): 235–54.CrossRefGoogle Scholar
Borges, André. 2011. The Political Consequences of Center-Led Redistribution in Brazilian Federalism: the Fall of Subnational Party Machines. Latin American Research Review 46, 3): 21–45.CrossRefGoogle Scholar
Brown, David S., and Hunter, Wendy. 1999. Democracy and Social Spending in Latin America, 1980–92. American Political Science Review 93, 4): 779–90.Google Scholar
Câmara Intergestores Tripartite (CIT). 2008. Municípios habilitados em gestão plena do Sistema Municipal de Saúde, Mayo de 2006. http://portal.saude.gov.br/portal/arquivos/pdf/municipios_gpsm_nob_noas_jun_2006_07_ago_2008_versao2.pdf. Accessed January 30, 2009.Google Scholar
Cameron, Maxwell A., and Hershberg, Eric. 2010. Latin America's Left Turns: Politics, Policies, and Trajectories of Change. Boulder: Lynne Rienner.Google Scholar
Castiglioni, Rossana. 2005. The Politics of Social Policy Change in Chile and Uruguay: Retrenchment versus Maintenance, 1973–1998. New York: Routledge.CrossRefGoogle Scholar
Coelho, Vera Schattan. 2006. Democratization of Brazilian Health Councils: the Paradox of Bringing the Other Side into the Tent. International Journal of Urban and Regional Research 30, 3): 656–71.Google Scholar
Conferěncia Nacional de Saúde (CNS). 1993. 9a Conferěncia nacional de saúde—relatório final: municipalização é o caminho. Brasília: Ministério da Saúde.Google Scholar
Conselho de Secretários de Saúde do Estado da Bahia (COSEMS-BA). n.d. Diretorias do COSEMS-BA 2005–2010. Internal documents.Google Scholar
Dagnino, Evelina. 2002. Sociedade civil e espaços públicos no Brasil. São Paulo: Paz e Terra/UNICAMP.Google Scholar
Neto, Dantas, Fábio, Paulo. 2006a. O Carlismo para além de Acm: estratégias adaptativas de uma elite política estadual. In Souza and Dantas Neto 2006. 247–86.Google Scholar
Neto, Dantas, Fábio, Paulo. 2006b. Surf nas ondas do tempo: do Carlismo histórico ao Carlismo pós-carlista. Caderno CRH 39: 213–35.Google Scholar
Díaz-Cayeros, Alberto. 2008. Electoral Risk and Redistributive Politics in Mexico and the United States. Studies in International Comparative Development 43, 2): 129–50.Google Scholar
Escorel, Sarah. 1998. Reviravolta na saúde: origem e articulação do movimento sanitário. Rio de Janeiro: Fiocruz.Google Scholar
Falleti, Tulia G. 2010. Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988. In Explaining Institutional Change: Ambiguity, Agency, and Power, ed. Mahoney, James and Thelen, Kathleen. New York: Cambridge University Press. 38–62.Google Scholar
Figueiredo, Argelina Cheibub, and Limongi, Fernando. 2000. Presidential Power, Legislative Organization, and Party Behavior in Brazil. Comparative Politics 32, 2): 151–70.CrossRefGoogle Scholar
Franco, Álvaro, Álvarez-Dardet, Carlos, and Teresa Ruiz, María. 2004. Effect of Democracy on Health: Ecological Study. BMJ 329: 1421–23.Google Scholar
Gauri, Varun, and Lieberman, Evan S.. 2006. Boundary Institutions and Hiv/Aids Policy in Brazil and South Africa. Studies in Comparative International Development 41, 3): 47–73.Google Scholar
Geddes, Barbara. 1994. Politician's Dilemma: Building State Capacity in Latin America. Berkeley: University of California Press.Google Scholar
Gibson, Christopher L. 2012. Civilizing the State: Civil Society and the Politics of Primary Public Health Care Provision in Urban Brazil. Ph.D. diss., Department of Sociology, Brown University.Google Scholar
Giraudy, Agustina. 2010. The Politics of Subnational Undemocratic Regime Reproduction in Argentina and Mexico. Journal of Politics in Latin America 2, 1): 53–84.Google Scholar
Grzymala-Busse, Anna. 2007. Rebuilding Leviathan: Party Competition and State Exploitation in Post-Communist Democracies. New York: Cambridge University Press.Google Scholar
Guimarães, Maria do Carmo. 2003. Processo decisório e conflitos de interesse na implementação da descentralização da saúde: um estudo das instâncias colegiadas na Bahia. Caderno CRH 39: 105–32.Google Scholar
Haggard, Stephan, and Kaufman, Robert R.. 2008. Development, Democracy, and Welfare States: Latin America, East Asia, and Eastern Europe. Princeton: Princeton University Press.Google Scholar
Hagopian, Frances. 1996. Traditional Politics and Regime Change in Brazil. New York: Cambridge University Press.Google Scholar
Hassenteufel, Patrick, Smyrl, Marc, Genieys, William, and Javier Moreno-Fuentes, Francisco. 2010. Programmatic Actors and the Transformation of European Health Care States. Journal of Health Politics, Policy and Law 35, 4): 517–38.Google Scholar
Hochman, Gilberto. 1998. A era do saneamento: as bases da política de saúde pública no Brasil. São Paulo: Hucitec/ANPOCS.Google Scholar
Huber, Evelyne, Mustillo, Thomas, and Stephens, John D.. 2008. Politics and Social Spending in Latin America. Journal of Politics 70, 2): 420–36.Google Scholar
Hunter, Wendy. 2010. The Transformation of the Workers' Party in Brazil, 1989–2009. New York: Cambridge University Press.Google Scholar
Immergut, Ellen M. 1992. Health Politics: Interests and Institutions in Western Europe. New York: Cambridge University Press.Google Scholar
Instituto Brasileiro de Geografica e Estatística (IBGE). 2000. Censo 2000. www.ibge.gov.br/censo Google Scholar
Nicolau, Jairo. n.d. Dados eleitorais do Brasil, 1982–2006. http://jaironicolau.iesp.uerj.br/banco2004.html. Accessed February 13, 2013.Google Scholar
Keck, Margaret. 1992. The Workers' Party and Democratization in Brazil. New Haven: Yale University Press.Google Scholar
La Forgia, Gerard M., and Couttolenc, Bernard F.. 2008. Hospital Performance in Brazil: The Search for Excellence. Washington, DC: World Bank.Google Scholar
Levcovitz, Eduardo, de Lima, Luciana D., and Machado, Cristiani V.. 2001. Política de saúde nos anos 90: relações intergovernamentais e o papel das normas operacionais básicas. Ciěncia e Saúde Coletiva 6, 2): 269–91.CrossRefGoogle Scholar
Levitsky, Steven, and Roberts, Kenneth M.. 2011. The Resurgence of the Latin American Left. Baltimore: Johns Hopkins University Press.Google Scholar
Lima, Luciana Dias de, and d'Ávila Viana, Ana L.. 2011. Descentralização, regionalização e instâncias intergovermentais no Sistema Único De Saúde. In Regionalização e relações federativas na política de saúde no Brasil, ed. Viana, . Rio de Janeiro: Contra Capa.Google Scholar
McGuire, James W. 2010. Wealth, Health, and Democracy in East Asia and Latin America. New York: Cambridge University Press.Google Scholar
Mendes, José D., and de Oliveira, Vanessa E.. 2009. Saúde pública paulista: 60 anos da secretaria de estado da saúde. São Paulo: SES-SP.Google Scholar
Ministério da Saúde/Secretaria de Gestão Estratégica e Participativa (MS/SGEP). 2006. A construção do SUS: histórias da reforma sanitária e do processo participativo. Brasília: Ministério da Saúde.Google Scholar
Montero, Alfred P. 2001. Shifting States in Global Markets. Subnational Industrial Policy in Contemporary Brazil and Spain. University Park, PA: Pennsylvania State University Press.Google Scholar
Montero, Alfred P. 2012. A Reversal of Political Fortune: the Transitional Dynamics of Conservative Rule in the Brazilian Northeast. Latin American Politics and Society 54, 1 (Spring): 1–36.Google Scholar
Motter, Paulino. 1994. O uso das concessões das emissoras de rádio e televisão no governo Sarney. Comunicação e Política 1, 1): 89–115.Google Scholar
Navarro, Vicente, and Shi, Leiyu. 2001. The Political Context of Social Inequalities and Health. Social Science and Medicine 52, 3): 481–91.Google Scholar
O'Neill, Kathleen. 2003. Decentralization as an Electoral Strategy. Comparative Political Studies 36, 9): 1068–91.CrossRefGoogle Scholar
Paim, Jairnilson. 2008. Reforma sanitária brasileira: contribuição para a compreensão e crítica. Salvador: EDUFBA.Google Scholar
Paim, Jairnilson, Travassos, Claudia, Almeida, Celia, Bahia, Ligia, and Macinko, James. 2011. The Brazilian Health System: History, Advances and Challenges. The Lancet 377, 9779): 1778–97.Google Scholar
Pimenta, Aparecida L. 2007. A história do CONASEMS: da fase heróica da década de 80 ao desejo de mudança do modelo de atenção e gestão dos anos 2000. Brasília: CONASEMS.Google Scholar
Power, Timothy J., and Zucco, Cesar Jr. 2012. Elite Preferences in a Consolidating Democracy: the Brazilian Legislative Surveys, 1990–2009. Latin American Politics and Society 54, 4 (Winter): 1–27.Google Scholar
Pribble, Jennifer. 2013. Welfare and Party Politics in Latin America. New York: Cambridge University Press.CrossRefGoogle Scholar
Pribble, Jennifer, Huber, Evelyne, and Stephens, John D.. 2009. Politics, Policies, and Poverty in Latin America. Comparative Politics 41, 4 (July): 387–407.Google Scholar
Ruger, Jennifer P. 2004. Health and Social Justice. The Lancet 364, 9439): 1075–80.Google Scholar
Samuels, David. 2003. Ambition, Federalism, and Legislative Politics in Brazil. Cambridge: Cambridge University Press.Google Scholar
Sartori, Giovanni. 1976. Parties and Party Systems: A Framework for Analysis. Cambridge: Cambridge University Press.Google Scholar
Schlesinger, Mark, and Lau, Richard R.. 2000. The Meaning and Measure of Policy Metaphors. American Political Science Review 94, 3): 611–26.Google Scholar
Sen, Amartya. 1999. Development as Freedom. New York: Anchor Books.Google Scholar
Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS). 2013. Database on public health budgets. http://siops.datasus.gov.br/evolpercEC29.php. Accessed June 20, 2011.Google Scholar
Souza, Celina. 1997. Constitutional Engineering in Brazil: The Politics of Federalism and Decentralization. New York: St. Martin's Press.Google Scholar
Souza, Celina, and Fábio Dantas Neto, Paulo, eds. 2006. Governo, políticas públicas e elites políticas nos estados brasileiros. Rio de Janeiro: Revan.Google Scholar
Sugiyama, Natasha Borges. 2008. Theories of Diffusion: Social Sector Reform in Brazil. Comparative Political Studies 41, 2): 193–216.CrossRefGoogle Scholar
Tribunal Superior Eleitoral. 1994–2006. Official database of election data. www.tse.jus.br/eleicoes. Accessed October 25, 2010.Google Scholar
Weyland, Kurt. 1996. Democracy Without Equity: Failures of Reform in Brazil. Pittsburgh: University of Pittsburgh Press.Google Scholar
World Health Organization (WHO). 2008. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Geneva: World Health Organization.Google Scholar
Zucco, Cesar, and Samuels, David. 2014. Crafting Mass Partisanship at the Grass Roots, from the Top down. British Journal of Political Science. Available on CJO2014. doi:10.1017/S0007123413000549.Google Scholar