B A N K I N G O N H E A LT H The World Bank and Health Sector Reform in Latin America SHIRI NOY Banking on Health Shiri Noy Banking on Health The World Bank and Health Sector Reform in Latin America Shiri Noy Department of Sociology University of Wyoming Laramie, WY, USA ISBN 978-3-319-61764-0 ISBN 978-3-319-61765-7 (eBook) DOI 10.1007/978-3-319-61765-7 Library of Congress Control Number: 2017944600 © The Editor(s) (if applicable) and The Author(s) 2017 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Cover credit: © Viorika/GettyImages Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To my parents, Ori and Dalia Noy A cknowledgements One of the reasons I find sociology so useful is that it highlights the social nature of individual undertakings. This book would not have been possible without the support of so many people. I owe a great debt of gratitude to my dissertation committee, as this project began at Indiana University, Bloomington. Patricia McManus has been an incredibly gen- erous and formidable mentor throughout the years. Together with the rest of my committee, Art Alderson, Clem Brooks, Bernice Pescosolido, and Brian Steensland, she has provided incisive and constructive feed- back on this project. I am also indebted to Brian Powell, who has always made himself available for questions and comments. I have also been fortunate to count on the personal and intellectual support of many friends and colleagues: Aaron Ponce, Abby Shaddox, Alya Guseva, Ann McCranie, Anna Zajacova, Carly Schall, Carrie Larson, Casey Oberlin, Christi Smith, Claudia Geist, Dana Prewitt, Dave Messenger, Dee Redmond, Dean Noy, Donna Barnes, Emily Bowman, Emily Meanwell, Evie Perry, Fabio Rojas, Jaime Kucinskas, Jamie and Deb Prenkert, Jenn and Dave Chonowski, J.D. Wolfe, Jelena Radovic Fanta, Jenny Stuber, Joe DiGrazia, Joe Harris, John and Carrie Shandra, Julia Obert, Juliana Martinez Franzoni, Kevin and Kelly Doran, Kyle Dodson, Laura Hamilton, Mandy Stewart, Marina Gerbin Landau, Malcolm Holmes, Matthew Painter, Michael Vassuer, Rashawn Ray, Richard Machalek, Ronen Noy, Sarah Hatteberg, Sharon Hamilton, Tanja Vuckovic Juros, Tiffany Julian, and Tim O’Brien. vii viii ACKNOWLEDGEMENTS I am especially grateful to all of the people who were so kind to me in Lima, Buenos Aires, and San Pedro and San Jose where I conducted my country case-study research. I especially thank my respondents for their generosity with their time, experiences, and information. In Peru, I thank Mariana, Adam, and Orit Pollak as well as the dearly departed Eugene and Aurelia Farkas (who I lovingly knew as Tata and Bobbi) who so kindly hosted me and made my stay so comfortable and wonderful. They are my second family, and they graciously open their home to me each time I visit. I also thank José Alberto Castro Quiroz and Liliana Vasquez who were especially helpful and whose office in the Ministry of Health became my headquarters of sort. In Costa Rica, I thank the Instituto de Investigaciones Sociales (IIS) at the University of Costa Rica that graciously hosted me during my time there and especially Koen Voorend and Fran Robles. In Buenos Aires, I thank Nacho Bontempo who made me feel so welcome and Federico Tobar and Carlos Vassallo, who were among my first interviewees and opened many subsequent doors for me. I also thank the several transcriptionists in all three coun- tries who helped me transcribe these interviews. I would not have been able to accomplish this research without funding from the Sociology department, the Center for Latin American and Caribbean Studies, and the Office for the Office of the Vice President for International Affairs at Indiana University. I am also thankful for the financial support from a National Science Foundation Dissertation Improvement Grant, an American Sociological Association Fund for the Advancement of the Discipline Grant, and a University of Wyoming Basic Research Grant. I am grateful to my editor at Palgrave Macmillan, Alexis Nelson, and editorial assistant Kyra Saniewski who were extraordinarily helpful and gracious in shepherding this book to publication. I thank my family for being so encouraging, in particular my brothers, aunts, uncles, cousins, and grandparents. I dedicate this book to my parents who have always supported me in everything I do, and are responsible for nurturing my curiosity—academic and otherwise. Without this sense of adventure, the desire to know how things work, especially in other places, I never would have embarked on this research. c ontents 1 The World Bank, Development, and Health 1 2 Neoliberalism and the World Bank’s Changing Approach to Health 45 3 The State of Health in Latin America: Trends and Correlates of Health Expenditures 65 4 Argentina: Mixed Outcomes While Coping with Crisis in a Planner State 93 5 Peru: Slow, Steady Health Reform in a Weak State 119 6 Costa Rica: The Challenges of Maintaining Universalism in a Strong State 145 7 Banking on Health: Variable Approaches and Contingent Outcomes 169 ix x CONTENTS Methodological Appendix: Comparative, Mixed-Methods Research: Challenges, Opportunities, and Some Practical Tips 189 Works Cited 235 Index 237 l f ist of igures Fig. 1.1 Comparison of cases along the analytical dimensions of state capacity and autonomy in health 30 Fig. 2.1 Development assistance for health globally, 1990–2013 57 Fig. 2.2 Development assistance for health in Latin America and the Caribbean, 1990–2013 58 Fig. 3.1 Trends in health spending in Latin America and the Caribbean 77 Fig. A.1 World Bank health sector-related projects in Argentina, Costa Rica, and Peru, approved between 1980 and 2005 204 xi