Affiliation: College of Arts and Sciences, Department of Political Science
Over the last decades, Latin American countries have attempted to expand access to healthcare and reform a system that discriminates based on the socioeconomic status of their citizens. Although previous research has posed that programmatic parties are important for policy quality, it has not shown the mechanisms through which programmatic parties can affect policy. Existing literature has also focused on the responsibility of strong left-wing parties for the expansion of social benefits, overlooking the development of reforms under right-wing governments. This study compares three processes of healthcare reform: the Chilean AUGE (Universal Access with Explicit Guarantees), enacted in the context of programmatic parties and a left-wing coalition in power, the Mexican Seguro Popular, approved in the context of programmatic parties and a right-wing party in power, and the Peruvian AUS (Universal Health Insurance), adopted in the context of non-programmatic parties and a right-wing party in power.
I argue that the programmatic commitments of parties, only present when the core values that unite party leaders relate to a policy issue, affect the quality of legislation. Reforms can follow a partisan path in which parties with values closely tied to the policy issue shape a reform’s specifications regarding implementation and funding. Reforms can also follow a non- partisan path in which parties disengaged from the definition of specifications allow technocrats without partisan ties to dominate the policymaking process. Given the lack of commitment from the main political actors, this leads to a policy that is poorly designed for effective implementation. Both paths can lead to reforms that increase formal coverage and even funding of the health sector. The key difference is in the feasibility of ensuring effective access to healthcare and the sustainability of funding. This study is based on 12 months of extensive field research in Chile, Mexico, and Peru, during which I conducted over 150 in-depth interviews with political elites, technocrats, and leaders of interest groups, accessed archives from the Legislatures and the Executives, and collected quantitative measures of the implementation of the reforms.