Reform and Electoral Competition: Convergence Toward Equity in Latin American Health Sectors

Scholars of Latin America disagree about the effects on equity of social policy reforms of the 1980s and 1990s. Those who see negative or no effects blame reforms, while those who believe welfare regimes have become more equitable attribute the change not to reform but to democracy and left governance. I resolve this disagreement by first developing a more holistic measure of equity. With this measure, I establish a convergence toward equity in the health sectors of Brazil, Colombia, and Chile. I then process-trace to determine the causal factors behind this convergence. Paradoxically, I find that the reform period was crucial because it gave rise to an alliance between technocrats and politicians facing electoral competition who together succeeded in overturning preexisting policy legacies, paving the way for equity. Left governance was not a significant factor behind this convergence, while democracy was important but has been underspecified.