Prevention policymaking and health systems in Latin America : why and when governments plan ahead

Abstract

Which political factors lead to prevention as a policy choice? I argue that prevention policy- making happens when the uncertainty of the decision-making environment is minimised, which happens in stable and resilient arrangements. My independent variables are policymaking sta- bility 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 mi- xed 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 Ameri- can 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 condi- tioned 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 do- cuments and interviews material. Governments’ preferences, financing priorities and how they conceptualise prevention over time have been shown to shape how the policy is designed.