A conformação da política de saúde no governo do MAS na Bolívia

Abstract

The thesis dissertation is centered in health policy reforms implemented in Bolivia during MAS left-wing government. By analyzing the reform processes, the main purpose is to understand if a left-wing government provides a more inclusive and comprehensive health policy, or if other political and institutional aspects are more relevant. Our aim is to provide a better comprehension of the left-turn in Latin America through the Bolivian case. In Bolivia, the reforms instituted after 1980s deepened health exclusion and pushed the constitution of a fragmented health system. In 2005, MAS victory in elections arose expectations of a reform in health policies. The main issues are: what is the effect of left-wing rising to presidency in Bolivian health policy? How that has affected the reconfiguration of the Bolivian health system? The working hypothesis is that the left-wing government has the effect of promoting more inclusive and universal health policy reforms. We also claim that no isolated factors assure institutional changes in policy arena. The qualitative study, focused on causal configurations and framed in an institutional approach, presumes that political decisions result from a combination of factors and institutions constrain and determine political actors' behavior. Besides presidential party ideology, central in the analysis, we take into consideration the party system in which the president is inserted, the intergovernmental relations between government levels and the legacy of health policies. The literature in the matter, governmental and campaign programs, health legal framework and other policy health related documents as well as interviews with MSD leaders are analyzed through a methodological mix of comparative historical analysis and process tracing. The results show that the conjunction of factors led to the frustration of a radical reform in health policy from a leftist government in Bolivia. Although the political and institutional context was favorable to the government and auspicious to a reform in health policy, the Executive's agenda was constrained especially by the very characteristics of the party: the nature constituted of diverse groups and internal interests and the disjunction between its two souls: social movement and government.