Constructing a Coalition to Break the Frozen Landscape: The Achievements and Limits of Healthcare Reform in Uruguay (2005-2014)

Abstract

The Broad Front Left Coalition came to power in 2005 with the promise of building a National Integrated Healthcare System in the context of a broader institutional environment that was quite resistant to the proposed reforms. An analysis of the healthcare reform process attempted by the government using the Advocacy Coalition Framework demonstrates that the promoter coalition was characterized by unstable agreements between the various actors in the coalition over the coalition’s core beliefs and project. This can be interpreted as a product of a conjuncture characterized by crisis. Once it was clear that the reform process guaranteed the survival of each actor, the existing political differences inside of the coalition and between the political and secondary aspects were overcome, but these differences could have put the breaks on the reformist impulse and brought about a new period of stasis or ‘freezing’. To confirm this hypothesis, this result could be explained by the sequence of implementation of the reforms, which at the same time brought with it political viability, strengthened actors that had been weakened in the reform process and reconstructed historical veto points.

Keywords

• Healthcare reform
• promoter coalitions
• institutional change
• Uruguay
• veto players