Decentralization, Participation and Inclusion? Reassessing Primary Health Care Delivery in Chile

Abstract

Since the early 1980s Chile has pursued a series of health sector reforms under a broadly neo-liberal framework. One of the principal claims made is that the introduction of decentralization and participation as part of the replacement of state activity by market arrangements has enhanced choice and the responsiveness of the system to individual and local needs. This chapter examines the mechanisms of decentralization and participation introduced within the neo-liberal approach in order to overcome social exclusion, focusing on the new model of primary health care delivery. Social exclusion can be understood in this context as the processes by which powerful groups restrict the access of outsiders to valued resources through a process of ‘social closure’. Consequently less powerful groups become polarized and are denied access to citizenship understood as full participation in the community² This process raises new questions regarding the role of the state and the community and highlights the importance of understanding the nature of participation.

The author would like to thank Paul Cammack and the editors for their helpful comments.