"Healthcare Reform out of Nowhere? Policy Reform and the Lack of Programmatic Commitment in Peru." 2021. Journal of Latin American Studies. Forthcoming.
The reform approved in Peru in 2009 during a right-wing government deviates from similar attempts to expand access to healthcare. Left-wing parties in Peru were extremely weak during the policymaking process and the political parties were non-programmatic. Based on original field research, this paper demonstrates how parties that lacked core values uniting their leaders and had no commitment to the reform did not care for the definition of specifications regarding funding and implementation. Instead, technocrats dominated the process of policy formation, which accompanied by the lack of commitment from key political actors, led to poorly specified policy and deficient implementation.
Are elected officials more responsive to men than women inquiring about access to government services? Women face discrimination in many realms of politics, but evidence is limited on whether such discrimination extends to interactions between women and elected officials. In recent years, several field experiments have examined public officials’ responsiveness. The majority focused on racial bias in the United States, while the few experiments outside the US were usually single-country studies. We explore gender bias with the first large-scale audit experiment in 5 countries in Europe (France, Germany, Ireland, Italy, Netherlands) and 6 in Latin America (Argentina, Brazil, Chile, Colombia, Mexico, Uruguay). A citizen alias whose gender is randomized contacts members of parliament about unemployment benefits or healthcare services. The results are surprising. Legislators respond significantly more to women (+3% points), especially in Europe (+4.3% points). In Europe, female legislators in particular reply substantially more to women (+8.4% points).
This article presents an analysis of the main political events of 2018. After the resignation of Pedro Pablo Kuczynski (PPK), the first year of Martín Vizcarra’s government began. His government faced numerous scandals triggered by the Lava Jato case, resulting in the detention of key politicians (including former presidents PPK and Ollanta Humala) and the transformation of the three branches of government. Moreover, a series of audio recordings uncovered a network of illegal under-the-table practices within the Judiciary, which included the protection of politicians and the negotiation of positions and reduction of penalties. In response, Vizcarra’s government promoted a group of institutional reforms via referendum, which are set in a context of institutional precariousness.
CHAPTERS IN EDITED VOLUMES
“Health Care and the public-private mix in Mexico, Chile and Peru." 2021. In Merike Blofield, Camila Arza, and Fernando Filgueira, eds. TheOxford International Handbook of Governance and Management for Social Policy. Latin America Section. Oxford University Press. Forthcoming.
This chapter provides an overview of the development of the public-private mix in healthcare in Mexico, Chile, and Peru. It outlines the development of the private sector in the 1980s and 1990s when the public health systems in all three countries struggled to provide insurance coverage to the majority of their population as well as access to healthcare services. This situation prompted the co-existence between the public and private sectors in a system characterized by fragmentation. One of the main consequences of these fragmented systems is the high out-of pocket expenditure citizens face. The states have sought aid from private providers to guarantee access to healthcare services for their populations. However, the governmental purchase of private services still remains marginal in the three countries. The important role of the private sector in the healthcare systems of Mexico, Chile, and Peru in terms of provision, insurance, and funding resembles a common trend in the Latin American region.
Latin American welfare states have undergone major changes over the past half century. As of 1980, there were only a handful of countries (Argentina, Brazil, Chile, Costa Rica, and Uruguay) with social policy regimes that covered more than half of their population with some kind of safety net to insure adequate care during their old age and that provided adequate healthcare services. With the turn of the century, the economic and political situation changed significantly. The commodity boom eased fiscal pressures and made resources available for an increase in public social expenditure. Democracy was more consolidated in the region and civil society had recovered from repression. Left-wing parties began to win elections and take advantage of the fiscal room which allowed for the building of redistributive social programs. The most significant innovation has been expansion of coverage to people in the informal sector and to people with insufficient histories of contributions to social insurance schemes. The overwhelming majority of Latin Americans now have the right to some kind of cash assistance at some point in their lives and to healthcare provided by their governments. In many cases, there have also been real improvements in the generosity of cash assistance, particularly in the case of non-contributory pensions, and in the quality of healthcare services. However, the least progress has been made toward equity. With very few exceptions, severe inequalities continue to exist in the quality of services provided through the new and the traditional programs.
BOOK PROJECT Political Parties and Policy Reform: Expansion of Healthcare in Latin America
Reforms seeking to expand access to social benefits promise to alleviate inequality. Yet, the political process behind the formation of these reforms can affect the prospects for tackling such disparity. Latin American countries have attempted to reform their highly unequal healthcare systems. What explains the variation in the quality of these reforms? I propose that the programmatic commitment of political parties affects the quality of legislation. Reforms can follow a path in which parties shape specifications regarding implementation and funding, or one in which disengaged parties allow technocrats without partisan ties to dominate the policymaking process. Both paths can increase formal coverage and even funding of the sector. The key difference is in the feasibility of granting effective access to healthcare and the sustainability of funding. I compare three reform processes that began in the 2000s: the Chilean AUGE, the Mexican Seguro Popular, and the Peruvian Universal Health Insurance.
Existing literature has focused on cases where strong left-wing parties were responsible for the expansion of social benefits. However, countries led by right-wing governments have also implemented healthcare reforms seeking expansion. Through the comparison of two processes of reform that took place with right-leaning parties in power (Mexico and Peru) and one under a left-wing coalition (Chile), I identify features of parties apart from ideology that influence policymaking.
MANUSCRIPTS IN PREPARATION
“Party-Voter Policy Congruence: Rethinking its Relationship to Clientelism." Under Review.
This article examines the level of congruence between representatives and supporters at the party level across seven policy issues: 1) the state’s responsibility in the provision of jobs, 2) pensions, 3) health care services, 4) ensuring the well-being of the people, 5) a state-run economy, 6) the reduction of inequality, and 7) same-sex marriage. I argue that party-voter policy congruence and clientelism can be compatible. I test this argument using elite and mass survey data on 53 political parties in 17 Latin American countries. I show that congruence is higher for parties showing higher levels of clientelism, regarding the public provision of excludable benefits, the state’s responsibility for ensuring the well-being of the people, and in the case of conservative parties, approval of same-sex marriage. Moreover, I find that left-wing parties are more congruent on socioeconomic issues than right-wing parties.
"Immigration in Europe and Latin America: A Comparative Analysis of Preferences," with Gabriele Magni. Presented at the 2019 Meeting of the Southern Political Science Association (SPSA) in Austin, TX.
Most of the work on immigration has focused on European countries and the United States. Yet, immigration has become a pressing issue in Latin America, as the flow of people to countries outside the region has reduced since the 2000s while immigration within Latin American countries has increased. Escalating violence and political and economic instability in countries like Venezuela have forced people to be displaced to neighboring countries, triggering diverse responses from the governments and citizens of the receiving countries. We develop a comparative analysis of Latin American and European countries to explore how the socio-economic and political context in which individuals live and the immigration policies adopted by governments affect immigration attitudes and decisions. Via conjoint experiments, we examine how natives of the receiving country react to immigration and form preferences on the issue depending on various factors such as the part of the country where they live as well as the origin and volume of immigrants.
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