Paper short abstract:

This paper discusses the complex relationship between processes of political liberalisation and social policy reforms by investigating the political factors behind the divergent paths in health reform, followed during the last two decades in Brazil and Mexico.

Paper long abstract:

This paper seeks to discuss the complex relationship between political liberalisation and social policy reform. The study is guided by the following research question: what type of institutional arrangements lie behind the generation of universalistic systems of social protection, and what type of institutional arrangements favour the reproduction of existing inequalities? Brazil and Mexico offer interesting comparable reasons to research the former as these two countries have undertaken different models of healthcare reform alongside the implementation of similar processes of political liberalisation. In Brazil a universalistic system (Sistema Único de Saúde) was instituted in 1988, whereas in Mexico an additional insurance programme (Seguro Popular de Salud) was layered to the existing social insurance programmes in 2002. Our argument is that the answer to this puzzle lies in the understanding of the effects of the institutional arrangements that existed at the time of the reforms. Drawing on historical institutionalism, we argue that while the production of a critical juncture was central to forge a universal healthcare system in Brazil, in the case of Mexico, political conditions favoured the reproduction of the system's fragmented nature. Three key dimensions triggered and shaped the different paths followed in the two countries: the type of political liberalisation, the system of industrial relations and the level of institutional influence of the left. Results show that social policy reform can serve the purpose of the conservation of power structures but it can also crystallise progressive change.