Privatization processes and institutional inequalities in health systems - Historical patterns and recent reforms in Argentina and El Salvador

Analysing the different cases of El Salvador and Argentina the paper shows how social inequalities in the access to health services have historically emerged and asks why major political actors took few initiatives to reduce them. It shows further that mechanisms of privatization, including user fees, health packages and privatization of health services have been very similar in both countries and increased existing social inequalities.  

While upper class members can easily access good medical treatment in both countries, poorer groups are confronted with huge access barriers. Argentina normally seen as one of the “pioneer countries” (Mesa-Lago) establishing social security has a similar high stratification as the “exclusionary system” (Filgueira/Filgueira) of El Salvador. 

The paper shows that health policy reflects social and political power relations and can be understood as an area of social conflict including struggles and compromises between different social groups. Structural paths were settled in the beginning of the 20^th century, when the first institutions of social protection were built. During the following decades more groups of the population got access to health care – but different reforms rather institutionalized inequalities than overcoming them, because they did not touch the interests of influential social groups.

In both countries critical junctures (Collier) in the years 2001-2003 produced a shift in political power relations that had a direct impact on the health sector: a large social movement against health privatization in El Salvador and the vast political and economic crisis in Argentina. The paper discusses up to which point a turn towards more equality oriented health policies can be observed afterwards.

The paper draws on recent literature on health reforms and social policy in Latin America. The case studies are informed by field research and expert interviews being part of a doctoral thesis in Political Science concluded in 2011.