Prevention Policymaking and Health Systems in Latin America: why and when governments plan ahead
prevention, path dependence, health systems, political institutions, latin america politics, dengue fever
Which political factors lead to prevention as a policy choice? I argue that prevention
policymaking happens when the uncertainty of the decision-making
environment is minimised, which happens in stable and resilient arrangements.
My independent variables are policymaking stability index, fiscal
decentralisation and health systems, and I condition their impact to path
dependence of the countries institutions and economy. I investigate these
associations in a mixed methods approach, by a Convergence Design. I operationalise
these variables as continuous indicators in a comparative OLS
regression model with error adjustment for seven Latin American countries.
I find that decentralisation is the most consistent covariate, compulsory insurance
health system models have a small but positive association, and
policymaking stability is conditioned by the inclusion of control variables
such as quality of government and cabinet ideology. In general, the strongest
models are lagged ten years before emphasis in prevention, showing the impact
of path dependence. Decentralisation is also a great driving force in my
case study of the Dengue Control Program in Brazil, as identified through
categorical aggregation of documents and interviews material. Governments’
preferences, financing priorities and how they conceptualise prevention over
time have been shown to shape how the policy is designed.