Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023)
This article explores the political and institutional factors that led two leftist governments to propose sweeping, rather than incremental, changes to earlier objective-oriented health systems reforms. One is the government of Mexico led by President Andrés Manuel López Obrador, who in 2019 propose...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Health Systems & Reform |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/23288604.2025.2461096 |
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| author | Laura Flamand Octavio Gómez-Dantés Natalia Losada-Trujillo Diana Pinto Edson Serván-Mori Diego Cerecero-García Thomas Hone Sumit Mazumdar |
| author_facet | Laura Flamand Octavio Gómez-Dantés Natalia Losada-Trujillo Diana Pinto Edson Serván-Mori Diego Cerecero-García Thomas Hone Sumit Mazumdar |
| author_sort | Laura Flamand |
| collection | DOAJ |
| description | This article explores the political and institutional factors that led two leftist governments to propose sweeping, rather than incremental, changes to earlier objective-oriented health systems reforms. One is the government of Mexico led by President Andrés Manuel López Obrador, who in 2019 proposed to replace reforms approved in 2003. His proposal was passed by Congress and implemented. The other is the government of President Gustavo Petro in Colombia, who in 2023 recommended the replacement of the health reform implemented in Colombia since 1993. His proposal was rejected by Congress. Drawing on historical institutionalism, we analyzed the interactions among actors and institutions that shaped their reform proposals, focusing on policy feedback effects and veto points. We examined news articles, government and policy documents, electoral results, presidential approval ratings, and legislative voting records. We also conducted in-depth interviews with key actors about the factors behind the need for reform, the policy proposals, and the public and legislative debates. In both countries, we found that a combination of policy feedback effects (political ideology beliefs, and policy legacies that shape public perceptions and expectations) and veto points (the perceived strength of the president vis-à-vis reform opponents) help explain the decisions to propose such significant changes to the health care systems. Based on these findings, we offer initial recommendations for safeguarding objective-oriented health system reforms in lower-middle and upper-middle-income countries facing stark political change, especially in polarized contexts. Objective-oriented health system reforms should be evidence-based and supported by long-term financing, delivery, management, and evaluation plans. For long-term resilience, they also need multiple networks to secure them, including citizens well informed about their benefits, health workers with a sense of ownership, and legal protections. |
| format | Article |
| id | doaj-art-2bdf5a1a297c40cc855fe0689e2415c8 |
| institution | Kabale University |
| issn | 2328-8604 2328-8620 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Systems & Reform |
| spelling | doaj-art-2bdf5a1a297c40cc855fe0689e2415c82025-02-06T16:23:42ZengTaylor & Francis GroupHealth Systems & Reform2328-86042328-86202024-12-0110310.1080/23288604.2025.2461096Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023)Laura Flamand0Octavio Gómez-Dantés1Natalia Losada-Trujillo2Diana Pinto3Edson Serván-Mori4Diego Cerecero-García5Thomas Hone6Sumit Mazumdar7Center for International Studies, The College of Mexico, Mexico City, MexicoCenter for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, MexicoInstituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia. Hospital Universitario Nacional de Colombia, Bogotá, ColombiaIndependent Researcher, Medellín, ColombiaCenter for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, MexicoDepartment of Primary Care and Public Health, Public Health Policy Evaluation Unit, Faculty of Medicine, School of Public Health, Imperial College London, London UKFaculty of Medicine, School of Public Health, Imperial College London, London, UKCentre for Health Economics, University of York, York, UKThis article explores the political and institutional factors that led two leftist governments to propose sweeping, rather than incremental, changes to earlier objective-oriented health systems reforms. One is the government of Mexico led by President Andrés Manuel López Obrador, who in 2019 proposed to replace reforms approved in 2003. His proposal was passed by Congress and implemented. The other is the government of President Gustavo Petro in Colombia, who in 2023 recommended the replacement of the health reform implemented in Colombia since 1993. His proposal was rejected by Congress. Drawing on historical institutionalism, we analyzed the interactions among actors and institutions that shaped their reform proposals, focusing on policy feedback effects and veto points. We examined news articles, government and policy documents, electoral results, presidential approval ratings, and legislative voting records. We also conducted in-depth interviews with key actors about the factors behind the need for reform, the policy proposals, and the public and legislative debates. In both countries, we found that a combination of policy feedback effects (political ideology beliefs, and policy legacies that shape public perceptions and expectations) and veto points (the perceived strength of the president vis-à-vis reform opponents) help explain the decisions to propose such significant changes to the health care systems. Based on these findings, we offer initial recommendations for safeguarding objective-oriented health system reforms in lower-middle and upper-middle-income countries facing stark political change, especially in polarized contexts. Objective-oriented health system reforms should be evidence-based and supported by long-term financing, delivery, management, and evaluation plans. For long-term resilience, they also need multiple networks to secure them, including citizens well informed about their benefits, health workers with a sense of ownership, and legal protections.https://www.tandfonline.com/doi/10.1080/23288604.2025.2461096Colombiahealth reformleft turnMexicopolitical economy |
| spellingShingle | Laura Flamand Octavio Gómez-Dantés Natalia Losada-Trujillo Diana Pinto Edson Serván-Mori Diego Cerecero-García Thomas Hone Sumit Mazumdar Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) Health Systems & Reform Colombia health reform left turn Mexico political economy |
| title | Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) |
| title_full | Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) |
| title_fullStr | Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) |
| title_full_unstemmed | Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) |
| title_short | Strengthening the Resilience of Objective-Oriented Health System Reforms. Analysis of the Left-Turn in the Health Reform Proposals in Mexico (2019) and Colombia (2023) |
| title_sort | strengthening the resilience of objective oriented health system reforms analysis of the left turn in the health reform proposals in mexico 2019 and colombia 2023 |
| topic | Colombia health reform left turn Mexico political economy |
| url | https://www.tandfonline.com/doi/10.1080/23288604.2025.2461096 |
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