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Institutional Constraints to Engendering the Health Sector in Bachelet’s Chile

  • Jasmine Gideon
  • Gabriela Alvarez Minte
Part of the Studies of the Americas book series (STAM)

Abstract

In recent years, scholarship examining the gendered nature of institutions has increased and offered much to our understanding of both the formal and informal practices that shape institutional practices, rules, norms, and processes of change. While the nature of formal and informal institutions themselves continues to be widely debated, there is a consensus, among feminist scholars at least, that they are inherently gendered (Chappell and Waylen 2013; Kenny 2007; Mackay, Kenny, and Chappell 2010; Waylen 2014, Waylen chapter 1 this volume). One question raised within this literature is how, despite the widespread promotion of “pro-gender” policy initiatives such as gender mainstreaming, the long-term gains have been limited. Michelle Bachelet, first as minister of health (2000–2002) and subsequently in her first presidential administration (2006–2010), sought to address the deeply embedded gender inequalities within the Chilean health sector through a number of policy initiatives. However, as this chapter demonstrates, a range of gendered institutional barriers has either constrained their effectiveness or limited the possibility of a long-term reform and many of the projects were either halted or dissipated during the subsequent right-wing government of Piñera (2010–2014). The second administration of Bachelet (2014 onward) offers a new opportunity to examine the potential for challenging some of the institutional constraints that limit gender equality in the health sector.

Keywords

Health Sector Emergency Contraception Informal Institution Health Reform Health Minister 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Adams, T. (2010). “Gender and Feminization in Health Care Professions,” Sociology Compass, 4/7: 454–465.CrossRefGoogle Scholar
  2. Agostini, C., Saavedra, E. and Willington, M. (2011). “Collusion on Private Health Insurance Coverage in Chile,” Journal of Competition Law and Economics, 7(1): 205–240.CrossRefGoogle Scholar
  3. Aguilera, X., Castillo-Laborde, C., Nájera-De Ferrari, M., Delgado, I., and Ibañez, C. (2014). “Monitoring and Evaluating Progress towards Universal Health Coverage in Chile,” PLOS Medicine, 11 (9), e1001676, http://www.plosmedicine.org/article/fetchObject.action?uri=infopercent3Adoipercent2F10.1371percent2Fjournal.pmed.1001676&representation=PDF.CrossRefGoogle Scholar
  4. Arcos, E., Poblete, J., Vega, I. M., Miranda, C., Zúñiga, Y., Fecci, E., Rodríguez, L., Márquez, M. and Ramírez, M. (2007). “Perspectiva de género en la formación de profesionales de la salud: Una tarea pendiente,” Rev Méd Chile, 135(6): 708–717.CrossRefGoogle Scholar
  5. Bitrán, R., Escobar, L., and Gassibe, P. (2010). “After Chile’s Health Reform: Increase in Coverage and Access, Decline in Hospitalization and Death Rates,” Health Affairs, 29(12): 2161–2170.CrossRefGoogle Scholar
  6. Bitrán, R. (2013). “Explicit Health Guarantees for Chileans: The AUGE Benefits Package,” Universal Health Coverage Studies Series, No. 21, Washington: World Bank.Google Scholar
  7. Brito Peña, A., Cid, Aguayo, B., and Donoso Orellano, C. (2012). “Ruling the Womb: The Sexual and Reproductive Struggle during Bachelet’s Administration,” Latin American Perspectives, 39(4): 145–162.CrossRefGoogle Scholar
  8. Casas, L. (2004). “La batalla de la Píldora. El acceso a la anticoncepción de emergencia en Amárica Latina,” Revista de Derecho ϒ Humanidades, 10: 183–208.Google Scholar
  9. Casas, L. and Vivaldi, L. (2013). “La penalización del aborto como una violación a los derechos humanos de las mujeres.” In T. Vial (Ed.), Informe anual sobre derechos humanos en Chile (pp. 69–120). Santiago Chile: Universidad Diego Portales.Google Scholar
  10. Centro de Derechos Humanos Universidad Diego Portales. (2012). Informe anual sobre derechos humanos en Chile 2012. Santiago Chile: Universidad Diego Portales.Google Scholar
  11. Chappell, L. (2010). “Comparative Gender and Institutions: Directions for Research,” Perspectives on Politics, 8(1): 183–189.CrossRefGoogle Scholar
  12. Chappell, L. and Waylen, G. (2013). “Gender and the Hidden Life of Institutions,” Public Administration, 91(3): 599–615.Google Scholar
  13. Comisión Asesora Presidencial para el Estudio y Propuesta de un Nuevo Marco Jurídico para el Sistema Privado de Salud. (2014). Informe Estudio y Propuesta de un Nuevo Marco Jurídico para el Sistema Privado de Salud. Santiago Chile.Google Scholar
  14. Connell, R. (2012). “Gender, Health and Theory: Conceptualizing the Issue, in Local and World Perspective,” Social Science and Medicine, 74, 1675–1683.CrossRefGoogle Scholar
  15. Contreras, D. and Sehnbruch, K. (2014). “Social Policies: From Social Debt to Welfare State?” In Sehnbruch, K. and Siavelis, P. (Eds.), Democratic Chile. The Politics and Policies of a Historic Coalition, 1990–2010 (pp. 243–262). Boulder, CO and London: Lynne Reiner Publishers.Google Scholar
  16. Díaz, S. and Schiappacasse, V. (2010). “Derechos sexuales y reproductivos en el gobierno de Michelle Cachelet.” In T. Valdés (Ed.), ¿Género en el poder? El Chile de Michelle Bachelet (pp. 19–42). Santiago Chile: CEDEM.Google Scholar
  17. Dides, C., Benavente, M. C., Sáez, I., Nicholls, L., and Correa, T. (2011). Provisión de Anticoncepción de Emergencia en el Sistema de Salud Municipal de Chile Estado de Situacion. Santiago Chile: Universidad Central—UNFPA Chile.Google Scholar
  18. Dirección del Trabajo. (2009). ENCLA 2008 Inequidades y Brechas de Género en el Empleo, Santiago Chile: Dirección del Trabajo.Google Scholar
  19. Economist Intelligence Unit (EIU). 2011. “Chile policy: remixing the mix.” November 23, 2011, Economist Intelligence Unit.Google Scholar
  20. El Mercurio. (September 27, 2014). “Presidente de Colmena y su renuncia a comisión de reforma a las isapres: Quieren estatizar. ElMercurio.” Retrieved from http://www.emol.com/noticias/economia/2014/09/27/682198/renuncia-gonzalo-de-la-carrera.html. Accessed October 12, 2014.
  21. Eyben, R. (2006) “The Road Not Taken: International Aid’s Choice of Copenhagen over Beijing,” Third World Quarterly, 27(4): 595–608.CrossRefGoogle Scholar
  22. Ewig, C. (2010) Second-Wave Neoliberalism: Gender, Race and Health Sector Reform in Peru. Pennsylvania: Pennsylvania State University Press.Google Scholar
  23. Ewig, C., and Kay S. J. (2011). “Post-retrenchment Politics: Policy Feedback in Chile’s Health and Pension Reforms,” Latin American Politics and Society, 53: 67–99.CrossRefGoogle Scholar
  24. Ewig, C., and Palmucci, G. A. (2012). “Inequality and the Politics of Social Policy Implementation: Gender, Age and Chile’s 2004 Health Reforms,” World Development, 40(12): 2490–2504.CrossRefGoogle Scholar
  25. Filgueira, F. (2005). “Welfare and Democracy in Latin America: The Development, Crises and Aftermath of Universal, Dual and Exclusionary Social States,” paper prepared for the UNRISD project on Social Policy and Democratization, Geneva: UNRISD.Google Scholar
  26. Gideon, J. (2006). “Integrating Gender Interests into Health Policy,” Development and Change, 37(2): 329–352.CrossRefGoogle Scholar
  27. Gideon, J. (2012). “Engendering the Health Agenda? Reflections on the Chilean Case, 2000–2010,” Social Politics, 19(3): 333–360.CrossRefGoogle Scholar
  28. Gideon, J. (2014). Gender, Globalization and Health in a Latin American Context. Basingstoke and New York: Palgrave.CrossRefGoogle Scholar
  29. Gjerberg, E. (2002). “Gender Similarities in Doctors’ Preferences and Gender Differences in Final Specialisation,” Social Science and Medicine, 54: 591–605.CrossRefGoogle Scholar
  30. Goetz, A. M. (1997). “Introduction: Getting Institutions Right for Women in Development.” In A. M. Goetz (Ed.), Getting Institutions Right for Women in Development (pp. 1–24). London and New York: Zed Press.Google Scholar
  31. Helmke, G. and Levitsky, S. (2004). “Informal Institutions and Comparative Politics: A Research Agenda,” Perspectives on Politics, 2(4): 725–740.CrossRefGoogle Scholar
  32. Infante, A., and Paraje, G. (2010). “Reforma de salud: Garantías exigibles como derecho ciudadano.” In O. Larrañaga and D. Contreras (Eds.), Las Nuevas Políticas de Protectión Social en Chile (pp. 77–118). Santiago de Chile: Uqbar Editores.Google Scholar
  33. Kenny, M. (2007). “Gender, Institutions and Power: A Critical Review,” Politics, 27(2): 91–100.CrossRefGoogle Scholar
  34. La Nación. (2007). “La trastienda de la batalla por la pastilla del día después: Dorando la píldora. La Nación.” Retrieved May 23, 2014, from http://recortes.iglesia.cl/recorte.php?id=7748.
  35. Lenz, R. (2007). “Proceso politico de la reforma AUGE de salud en Chile: algunas lecciones para América Latina. Una mirada desde la economía política,” Serie Estudios Socio/Económicos No. 38, Santiago: CIEPLAN.Google Scholar
  36. Mackay, F., Kenny, M., and Chappell, L. (2010). “New Institutionalism Through a Gender Lens: Towards a Feminist Institutionalism?,” International Political Science Review, 31(5): 573–588.CrossRefGoogle Scholar
  37. Mesa-Lago, C. (2008) Reassembling Social Security: A Survey of Pension and Health Care Reforms in Latin America. Oxford: Oxford University Press.Google Scholar
  38. Ministry of Health (MINSAL) (2001), Transversalización de la Perspectiva de Género en las Políticas de Reforma de Salud en Chile. Santiago, Chile: MINSAL.Google Scholar
  39. Ministerio de Salud, Recursos para la Salud—DEIS. Available at: http://www.deis.cl/?p=37 Accessed November 4, 2015.
  40. Molyneux, M. (2007). “Change and Continuity in Social Protection: Mothers at the Service of the State,” Gender and Development Papers, No. 1, UNRISD, Geneva.Google Scholar
  41. Montecinos, V. (2009). “Economics: The Chilean story.” In V. Montecinos and J. Markoff (Eds.), Economists in the Americas. Cheltenham and Northampton, MA: Edward Elgar, pp. 142–194.CrossRefGoogle Scholar
  42. Muñoz, M. S. (2004). Reforma de Salud y Equidad de Género Contenidos, Chile: Superintendencia de Salud, available at http://www.supersalud.gob.cl/documentacion/569/articles-4013_recurso_1.pdf, last accessed November 12, 2014.
  43. Murray, S. and Elston, M. A. (2005). “The Promotion of Private Health Insurance and Its Implications for the Social Organisation of Healthcare: A Case Study of Private Sector Obstetric Practice in Chile,” Sociology of Health & Illness, 27(6): 701–721.CrossRefGoogle Scholar
  44. Nunez, A. and Chi, C. (2013). “Equity in Health Care Utilization in Chile,” International Journal for Equity in Health, 12:58, http://www.equity-healthj.com/content/12/1/58, accessed October 20, 2014.
  45. OPS/OMS. (2002). “Discriminación de las mujeres en el Sistema de Instituciones de Salud Previsional. Regulación y perspectiva de género en la reforma’.” Género, Equidad y Reforma de la Salud en Chile, Working Paper No 1. Santiago, Chile: OPS/OMS.Google Scholar
  46. Paraje, G. and Vásquez, F. (2012). “Health Equity in an Unequal Country: The Use of Medical Services in Chile,” International Journal for Equity in Health 2012, 11:81, http://www.equityhealthj.com/content/pdf/1475-9276-11-81.pdf. Accessed October 20, 2014.Google Scholar
  47. Pribble, J. (2013). Welfare and Party Politics in Latin America. Cambridge and New York: Cambridge University Press.CrossRefGoogle Scholar
  48. Pribble, J. and Huber, E. (2010). “Social Policy and Redistribution under Left Governments in Chile and Uruguay,” Colegio Carlo Alberto, Working Paper no. 177, http://www.carloalberto.org/assets/working-papers/no.177.pdf.
  49. Provoste, P. and Berlagoscky, F. (2002). “Modelo de atención y género: Las condiciones socioculturales de la reforma de la salud en Chile. Género, Equidad y Reforma de la Salud en Chile,” Working Paper No. 4. Santiago, Chile: Organización Panamerícana de la Salud/Organización Mundial de la Salud.Google Scholar
  50. Rosemblatt, K. A. (2001). “Charity, Rights, and Entitlement: Gender, Labor, and Welfare in Early-Twentieth-Century Chile,” Hispanic American Historical Review, 81(3–4), 555–587.CrossRefGoogle Scholar
  51. Sandall, J., Benoit, C., Wrede, S., Murray, S. F., van Teijlingen, E., and Westfall, R. (2009). “Social Service Professional or Market Expert?: Maternity Care Relations under Neoliberal Healthcare Reform,” Current Sociology, 57(4): 529–553.CrossRefGoogle Scholar
  52. Staab, S. and Waylen, G. (2014). “Understanding Gender in the Executive: Politics, Institutions and Policy Change in Bachelet’s Chile,” paper, ECPR joint sessions, Salamanca, April.Google Scholar
  53. Superintendencia de Salud. (2007a). Avance en el Monitoreo de la Reforma y su Impacto en los Beneficiarios del Sistema ISAPRE. Parte II (pp. 1–24).Google Scholar
  54. Superintendencia de Salud. (2007b). Evaluación de la Reforma de Salud y Situación del Sistema Isapres. Diseño Metodológico y Definición de Líneas Basales (pp. 1–35). Santiago Chile.Google Scholar
  55. Superintendencia de Salud/Datavoz. (2014a). “Informe cualitativo ‘estu-dio de usuarios del sistema de salud y prestadores respecto de la ley de derechos y deberes’”, available at http://www.supersalud.gob.cl/docu-mentacion/569/articles-9821_recurso_1.pdf, last accessed October 26, 2014.
  56. Superintendencia de Salud/Datavoz. (2014b). “Estudio de opinión a usuarios del sistema de salud, reforma y posicionamiento de la Superintendencia de Salud,” available at http://www.supersalud.gob.cl/documentacion/569/articles-9184_recurso_1.pdf, last accessed October 26, 2014.
  57. Tamayo, M. and Rebolledo, J. (2011). “Garantía de oportunidad, artrosis y autorreporte de salud en personas con artrosis en una comuna de la Región Metropolitana,” Rev Med Chile, 139: 1617–1623.CrossRefGoogle Scholar
  58. Valdés, X., Caro, P., and Peña, D. (2001). “Género, familia y matrimonio: La visión de las visitadoras sociales católicas entre 1930–1950,” Revista de la Academia, 6 (Primavera): 177–206.Google Scholar
  59. Vargas, V. and Poblete, S. (2008). “Health Prioritization: The Case of Chile.” Health Affairs, 27:782–792.CrossRefGoogle Scholar
  60. Waylen, G. (2014). “Informal Institutions, Institutional Change, and Gender Equality.” Political Research Quarterly, 67(1): 212–223.CrossRefGoogle Scholar
  61. Wildschut, A. (2010). “Exploring Internal Segregation in the South African Medical Profession,” Journal of Workplace Learning, 22(1/2): 53–66.CrossRefGoogle Scholar
  62. Zarate, M. (2001). “Notas preliminares sobre profesión médica y masculinidad, Chile, Siglo XIX.” In J. Olavarría (Ed.), Hombres: identidad/es y violencia, Red Masculinidad/es (pp. 73–84). Santiago, Chile: FLACSO Chile, Academia de Humanismo Cristiano.Google Scholar
  63. Zúñiga, A. (2007) “Sistemas sanitarios y reforma AUGE en Chile”, Acta Bioethica 2007; 13(2): 237–245.Google Scholar
  64. Zúñiga, A. (2014). “When Constitutional Justice Has the Last Word on Health Care: The Case of Chile,” International Journal of Health Services, 44(2): 373–381.CrossRefGoogle Scholar

Copyright information

© Jasmine Gideon and Gabriela Alvarez Minte 2016

Authors and Affiliations

  • Jasmine Gideon
  • Gabriela Alvarez Minte

There are no affiliations available

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