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Public Organization Review

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17.07.2021

An Inter-Temporal Comparison About the Effect of Institutional Changes on the Policy-Making Process in Chile’s Health Sector

verfasst von: Mauricio Olavarria-Gambi

Erschienen in: Public Organization Review | Ausgabe 2/2022

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Abstract

Do institutional changes lead to changes in the policy formulation process (PFP)? The paper analyses the health sector PFP of the old Chilean democracy (in place until 1973), until mid 1950s, and contrasts its finding with that of the democratic regime in place since 1990. Deep institutional reforms occurred in between, during the 17-year dictatorship of General Pinochet. The article concludes that both PFP behave similarly, raising the question of why is that and what might explain it. Information comes from official documents, press clippings, diverse literature and interviews. The article combines policy analysis with documental historical and hermeneutical methods.

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The expression new Chilean democracy refers to the period starting in March 11, 1990, which marks the end of General Pinochet’s dictatorship.

PFP analyzed by Olavarría (2016: 159) are those of public management “modernization policy, the health-care reform, the Santiago urban transportation plan (popularly known as Transantiago), and the policy on transparency and access to public information.”.

The term Old Chilean democracy indicates the period that ended with the coup d’etat of September 11, 1973 that overthrew President Salvador Allende.

As of 2021, there are 16 Chilean regions.

After that, the following health reforms were implemented in Chile: that of 1980, which implemented a pre-paid health insurance mechanism, known as ISAPREs; and that of 2004–2005 on a Universal Access Plan to Explicit Guarantees of Health, known as Plan AUGE (as per its title in Spanish).

Since an informed consent form, assuring anonymity, was signed, their names cannot be disclosed.

The “noise of sabers” occurred when a committee of young militaries attended the congressional sessions of September 8- 9, 1924, making noises with their sabers as a protest to parliamentarians who procrastinated on approving several social bills, including an increase in military salaries, sent by the government.

The Ministry changed denomination again in 1953 to Ministry of Public Health and Social Security and, in 1959, it was divided into the Ministry of Public Health and the Ministry of Labor and Social Security (Ministerio de Salud Publica, 2018).

For instance, general mortality and mortality caused by flu and pneumonia were much higher in Chile than in European, North American and several Latin American countries; and the same happened with other health indicators such as infant mortality at birth, which was 50.5 per 1,000 births in 1938; maternal mortality was 51.8 per 1,000 in 1937, mortality caused by tuberculosis was 400 per 100,000 inhabitants in 1934, mortality caused by typhus was 10.5 in 1936, and sexually transmitted diseases appeared to be out of control by 1930s (Allende, 1939).

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Titel: An Inter-Temporal Comparison About the Effect of Institutional Changes on the Policy-Making Process in Chile’s Health Sector
verfasst von: Mauricio Olavarria-Gambi
Publikationsdatum: 17.07.2021
Verlag: Springer US
Erschienen in: Public Organization Review / Ausgabe 2/2022
Print ISSN: 1566-7170
Elektronische ISSN: 1573-7098
DOI: https://doi.org/10.1007/s11115-021-00543-3

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