Argentina: Mixed Outcomes While Coping with Crisis in a Planner State

Abstract

This chapter traces the process of health sector reform in Argentina between 1980 and 2005. The chapter interrogates how and why the World Bank became involved in health sector reform in Argentina, the country with which the Bank has had the most extensive, and many would argue successful, relationship in health in the region. In 1989, then Argentinian health minister, Aldo Neri, with support from the federal government, attempted to introduce a universal public health system. This reform failed, largely due to opposition by the trade-based insurance funds that dominate the Argentinian health market, the Obras Sociales. In this chapter, I examine the reforms that the government pursued in the aftermath of this failed reform, and how World Bank’s involvement shaped the direction of future reform in the context of this health system and the broader political and macro-economic national realities. Drawing on World Bank project and loan documents on national health plans and documents together with over two dozen interviews with policy makers, civil society activists, World Bank personnel, and other experts, I find that the World Bank advanced an agenda of targeted interventions in the context of a fragmented system. This chapter describes Argentina as a planner state: characterized by a capable technical expertise and an ambitious health reform plan, but an inability to carry out broad reforms because of divisions within the health system and powerful opposing actors. I conclude this chapter by discussing the implications of this case for our understanding of the ways in which high national autonomy and but weak state capacity in health (the case of Argentina) conditions how international financial institutions and other organizations can affect health sector reform.

“[In the 1980s and 1990s] we went through a crisis of foreign debt, inflation and strong battles over distribution…The discussion of a national health insurance, in which, while the trade unions were still involved as important players, would mean a power cut for them, and at that time conditions made their resistance very effective…We did not manage to implement national health insurance”

—interview with Dr. Aldo Neri, Minister of Health of Argentina between 1983–1986 and the architect of a failed plan for national health insurance on reasons for its failure (Interview #74)