Strengthening the resilience of objective-oriented health system reforms. Analysis of the left-turn in the health reform proposals in Mexico (2019) and Colombia (2023)
Author(s)
Type
Journal Article
Abstract
This article explores the political and institutional factors that led two leftist governments to propose sweeping, rather than incremental, changes to earlier objective-oriented health systems reforms. One is the government of Mexico led by President Andrés Manuel López Obrador, who in 2019 proposed to replace reforms approved in 2003. His proposal was passed by Congress and implemented. The other is the government of President Gustavo Petro in Colombia, who in 2023 recommended the replacement of the health reform implemented in Colombia since 1993. His proposal was rejected by Congress. Drawing on historical institutionalism, we analyzed the interactions among actors and institutions that shaped their reform proposals, focusing on policy feedback effects and veto points. We examined news articles, government and policy documents, electoral results, presidential approval ratings, and legislative voting records. We also conducted in-depth interviews with key actors about the factors behind the need for reform, the policy proposals, and the public and legislative debates. In both countries, we found that a combination of policy feedback effects (political ideology beliefs, and policy legacies that shape public perceptions and expectations) and veto points (the perceived strength of the president vis-à-vis reform opponents) help explain the decisions to propose such significant changes to the health care systems. Based on these findings, we offer initial recommendations for safeguarding objective-oriented health system reforms in lower-middle and upper-middle-income countries facing stark political change, especially in polarized contexts. Objective-oriented health system reforms should be evidence-based and supported by long-term financing, delivery, management, and evaluation plans. For long-term resilience, they also need multiple networks to secure them, including citizens well informed about their benefits, health workers with a sense of ownership, and legal protections.
Date Issued
2024-12-18
Date Acceptance
2025-01-28
Citation
Health Systems & Reform, 2024, 10 (3)
ISSN
2328-8604
Publisher
Informa UK Limited
Start Page
2461096
Journal / Book Title
Health Systems & Reform
Volume
10
Issue
3
Copyright Statement
© 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), whichpermits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has beenpublished allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39913159
Subjects
Colombia
Mexico
health reform
left turn
political economy
Colombia
Health Care Reform
Humans
Mexico
Politics
Health Policy
Publication Status
Published
Coverage Spatial
United States
Article Number
2461096
Date Publish Online
2025-02-06