“Understanding health policy change in post-dictatorship Chile (2000-2006): an Advocacy Coalition Framework analysis”.

摘要

This thesis examines the political process of the health reforms enacted in Chile during the Presidency of Ricardo Lagos (2000-2006). The Advocacy Coalition Framework (ACF) is used to answer the question: How were the health reforms during the Lagos administration of 2000-6 achieved within the existing institutional arrangements that were put in place during the authoritarian period? As emphasised by the historical institutionalist literature, Chilean politics, since the return to democracy, has been characterised by inertia and limited transformation. My research seeks to understand how it was possible to bring about policy change in a context in which everything seemed fixed. The contribution of this thesis is twofold: first, examining the health policy reform through the lens of the ACF, this study contributes to expand the theoretical development of this framework. Second, this study contributes to enrich the existent literature about the Chilean case, analysing original data to identify the factors that enable policy change. Focusing on explanations for policy change suggested by the ACF, the findings suggest that health reform was achieved through a path of negotiated agreement. This agreement was facilitated by three main factors: an evolution of coalitions, the strategic mobilisation of resources, and the institutional arrangements inherited from the authoritarian regime. Using a qualitative case study, informed by the international health policy literature, and using the ACF as a theoretical framework, the Chilean case is scrutinised. Evidence was gathered through an appraisal of data collected from a variety of documentary sources, as well as the thematic analysis of transcriptions of congressional hearings and 26 semi-structured elite interviews. Applying ACF allowed me to identify and understand the dynamics of the Chilean health reforms, by examining how actors grouped into coalitions, shared belief systems, and acted strategically to determine the outcome of the reforms.