Mas mercado, menos estado? Neoliberal pressures and health sector reform in Argentina, Costa Rica and Peru

How do developing countries respond to, resist, contest and negotiate uniform neoliberal pressures to reform social services? This research examines how Peru, Costa Rica and Argentina were able to negotiate powerful neoliberal international financial institutions pressures towards increased privatization in and diminished state responsibility for healthcare. International financial institutions, namely the International Monetary Fund and the World Bank, have been central movers in diffusing neoliberal ideas via loan agreements and structural adjustment programs. Thus far, countries have responded differently to these pressures, and a comparative approach allows a focus on how states negotiate and what conditions allow countries to resist these pressures. Most studies about the role of the state in ensuring and regulating healthcare have been limited to advanced industrial democracies with established welfare states. Latin America is an ideal region in which to explore the dynamics of globalization, state building and welfare state development given its increased integration into the global economy, uneven democratic history, high levels of economic growth and inequality and the heavy presence of international financial institutions. I argue that homogenizing pressures for neoliberal health sector reforms were differentially resisted, contested and negotiated in Peru, Costa Rica and Argentina owing their distinctive political and economic histories and institutional arrangements. I use data from interviews with policy makers (ministry of health and social security personnel, international organization personnel, etc.) and analysis of policy documents (national health plans, international loan agreements, etc.) to examine the process of health sector reform in three countries: Peru, Costa Rica and Argentina.