Book contents
- Frontmatter
- Contents
- List of Illustrations
- Contributors
- Preface
- Explaining Institutional Change
- 1 A Theory of Gradual Institutional Change
- 2 Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988
- 3 The Contradictory Potential of Institutions: The Rise and Decline of Land Documentation in Kenya
- 4 Policymaking as Political Constraint: Institutional Development in the U.S. Social Security Program
- 5 Altering Authoritarianism: Institutional Complexity and Autocratic Agency in Indonesia
- 6 Rethinking Rules: Creativity and Constraint in the U.S. House of Representatives
- 7 Historical Institutionalism in Rationalist and Sociological Perspective
- Index
- References
2 - Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988
Published online by Cambridge University Press: 05 June 2012
Book contents
- Frontmatter
- Contents
- List of Illustrations
- Contributors
- Preface
- Explaining Institutional Change
- 1 A Theory of Gradual Institutional Change
- 2 Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988
- 3 The Contradictory Potential of Institutions: The Rise and Decline of Land Documentation in Kenya
- 4 Policymaking as Political Constraint: Institutional Development in the U.S. Social Security Program
- 5 Altering Authoritarianism: Institutional Complexity and Autocratic Agency in Indonesia
- 6 Rethinking Rules: Creativity and Constraint in the U.S. House of Representatives
- 7 Historical Institutionalism in Rationalist and Sociological Perspective
- Index
- References
Summary
Policy in Brazil changes by accretion rather than by substitution.
Schmitter 1971, 256In the last two decades, Brazil's health care system has undergone two major transformations: universalization and municipalization. Prior to 1988, the administration of the health care system was centralized in the federal government. The member states and the municipalities had a minimal role in the management and delivery of health care. National funding was channeled, via contracts, to the private sector, and inequalities in the provision of services were pervasive. A large portion of the population did not have access to health care, either because they were uninsured or because there were no health facilities in the areas where they lived.
Two decades later the system has been radically reconfigured. In the new health care system, coverage is universal, access is free, public services are integrated, and the delivery of health care is decentralized. The private sector continues to exist alongside the public sector, but its importance as a contractor for the public system has diminished significantly. The Brazilian states and some of the large municipalities are responsible for high-complexity health services, and all of the municipalities – more than fifty-five hundred in total – deliver basic health care services.
This development is puzzling in light of existing theories that all point to insurmountable political barriers to universalization in a context such as Brazil. Several features of the previous system should have dampened efforts in this direction.
- Type
- Chapter
- Information
- Explaining Institutional ChangeAmbiguity, Agency, and Power, pp. 38 - 62Publisher: Cambridge University PressPrint publication year: 2009
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