Administrative reforms and public-private participation in welfare systems. A comparative analysis of Health Sector Reforms in Colombia, Mexico and Chile

Reforms to the public sector have been considered as a means by which the government can transform many of the relations between the State and the citizen to improve the provision of public services. These reforms have been... [ view full abstract ]

Reforms to the public sector have been considered as a means by which the government can transform many of the relations between the State and the citizen to improve the provision of public services. These reforms have been aimed at coping two great dimensions, on the one hand, the introduction of management tools of the private sector, and on the other, the incorporation of elements of the new institutionalism in economics. This implies not only changes in the functioning of public organizations, but also a closer relationship with the private sector for the provision of services, for example in social welfare systems, whether in health or pensions. This proximity to the private sector, in its various forms such as contractualisation, privatization, and others forms such as out sourcing, even in the construction of new forms of regulation/collaboration, has brought a set of tensions for the State in the implementation processes, especially when they are associated with public policies in particular, such as health, pensions and poverty alleviation.

Our research question aims to answer how has the State developed a new role vis-à-vis private actors in the provision of social welfare goods in the context of Latin America. This article analyzes precisely the development of these tensions and their relation with the institutional capacity of the State in particular with the development of public private partnerships in the health sector in Colombia, Chile and Mexico. The purpose is to conduct a comparative analysis on the main variables that have influenced the capacity of the State in the case of private sector participation in the health sector. We will follow a mixed methods approach in order to analyze, changes in institutional capacity aiming to understand how the State has started to develop a combination of old and new duties as implementer, regulator or collaborator. The article aims to expose the dilemmas and tensions produced by the proximity of the private sector and its implications in terms of improving the performance of social welfare systems.