As três versões do neo-institucionalismo
TL;DR: The authors define a "neo-institucionalism" which constitui uma corrente de pensamento unificada, i.e., a set of metodos de analise diferentes apareceram nessa area no ultimo quarto de seculo.
Abstract: O neo-institucionalismo nao constitui uma corrente de pensamento unificada. Ao contrario, pelo menos tres metodos de analise diferentes apareceram nessa area no ultimo quarto de seculo: o institucionalismo historico, o institucionalismo da escolha racional e o institucionalismo sociologico. Todas elas tratam, por ângulos diferentes, do papel desempenhado pelas instituicoes na determinacao de resultados sociais e politicos. Expoe-se e examina-se a genese de cada uma dessas variantes do "neo-institucionalismo", assim como o que distingue suas maneiras de tratar dos problemas sociais e politicos.
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TL;DR: In this article, the authors analyzed the federal performance in the intergovernmental coordination of national health policy during the period of implantation of the Unified Health System (SUS), based on a research about the role of the Brazilian Ministry of Health from 1990 to 2002, which involved documental analysis and interviews with federal officers.
Abstract: This article deals with intergovernmental relations in health within the 20 years of implantation of the Unified Health System (SUS), in the light of the historical course of Brazilian federalism and its implications to health. Initially, a theoretical-conceptual review was carried out on the topic of federalism, social welfare and federative coordination of health, considering the international debate and the historical analysis of the Brazilian case. Following, the article analyzes the federal performance in the intergovernmental coordination of national health policy during the period of implantation of SUS, based on a research about the role of the Brazilian Ministry of Health from 1990 to 2002, which involved documental analysis and interviews with federal officers and other players in national politics. It was observed that health policies registered, in the past 20 years, changes in five relevant aspects that characterize federalism: institutional arrangements and rules for decisions in the federal government; the set of players with territorial basis; legal arrangements to define responsibilities among government levels; intergovernmental tax arrangements; informal arrangements among governments - vertically and horizontally.
69 citations
TL;DR: In this paper, a politica nacional de reorientacao da formacao profissional em saude, desenvolvida a partir de 2003, and seus antecedentes, is analyzed.
Abstract: Este artigo analisa a politica nacional de reorientacao da formacao profissional em saude, desenvolvida a partir de 2003, e seus antecedentes. Destaca marcos e transformacoes no percurso temporal da politica de 1980 a 2010, elementos de continuidade e mudancas e conexoes existentes entre iniciativas anteriores e a politica atual. O estudo envolveu revisao de literatura sobre o tema e analise documental apoiados no referencial teorico de analise das politicas publicas, em especial o institucionalismo historico. Os resultados apontam quatro distintos momentos da trajetoria da politica, demarcados por inflexoes nas iniciativas de reorientacao da formacao superior em saude: antecedentes; experiencias iniciais; protagonismo universitario; ampliacao e aprimoramento. Como elemento de continuidade, nota-se permanencia dos eixos norteadores nos objetos preconizados nas politicas. As evidencias de implementacao expressam perspectiva de ampliacao, com diversificacao dos atores e organizacoes mobilizados, e mais projetos implantados. A experiencia acumulada sugere amadurecimento das bases estruturantes das acoes e as principais mudancas referem-se a valorizacao das instâncias decisorias do SUS e a aproximacao com o processo de descentralizacao e regionalizacao da politica nacional de saude.
65 citations
TL;DR: In this article, the authors examined the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process.
Abstract: This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.
65 citations
TL;DR: The results point to four different moments during the trajectory of the policy, marked by changes in the initiatives of reorientation of higher education in health: antecedents; initial experiences; university protagonism; broadening and enhancement.
Abstract: This paper examines the national policy and its antecedents for reorientation of professional health training implemented after 2003. It highlights landmarks and transformations in the course of policies between 1980 and 2010, elements of continuity and change and the connections between past and current policy initiatives. The study involved a review of the literature on the subject and document analysis supported by theoretical analysis of public policies, particularly historical institutionalism. The results point to four different moments during the trajectory of the policy, marked by changes in the initiatives of reorientation of higher education in health: antecedents; initial experiences; university protagonism; broadening and enhancement. As an element of continuity, there is the permanence of objects in the guiding principles advocated in the policies. The evidence of implementation expresses prospects of enhancement, with diversification of mobilized actors and organizations, and more projects implemented. The accumulated experience suggests structural maturity of the structural bases of action and the main changes relate to the enhancement of decision-making bodies of the SUS and the approximation to the process of decentralization and regionalization of national health policy.
63 citations
TL;DR: In this article, the authors analyzed the national implementation of the Health Pact between 2006 and 2010 involving a strategy that reconfigures intergovernmental relations in the sector, including its implications for health policy.
Abstract: Decentralization and regionalization represent constitutional guidelines for the organization of the Unified Health System, which in the last 20 years has required the adoption of mechanisms to coordinate and accommodate federative tensions in Brazil's healthcare sector. This paper analyzes the national implementation of the Health Pact between 2006 and 2010 involving a strategy that reconfigures intergovernmental relations in the sector. The study involved the analysis of documents, official data and interviews with federal, state and municipal managers in the Brazilian states. The content of the national proposal is initially discussed, including its implications for health policy. The different rhythms and degrees of implementation of the Health Pact are then reviewed, with respect to adherence by states and municipalities and the formation of Regional Management Boards. Lastly, the conditioning factors for the multiplicity of experiences observed in the country are identified and the challenges facing progress toward a decentralized and regionalized health system in Brazil are discussed.
57 citations
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TL;DR: Many formal organizational structures arise as reflections of rationalized institutional rules as discussed by the authors, and the elaboration of such rules in modern states and societies accounts in part for the expansion and i...
Abstract: Many formal organizational structures arise as reflections of rationalized institutional rules. The elaboration of such rules in modern states and societies accounts in part for the expansion and i...
23,073 citations
TL;DR: The population problem has no technical solution; it requires a fundamental extension in morality.
Abstract: The population problem has no technical solution; it requires a fundamental extension in morality.
22,421 citations
TL;DR: For example, the authors argues that culture influences action not by providing the ultimate values toward which action is oriented, but by shaping a repertoire or "tool kit" of habits, skills, and styles from which people construct "strategies of action."
Abstract: Culture influences action not by providing the ultimate values toward which action is oriented, but by shaping a repertoire or "tool kit" of habits, skills, and styles from which people construct "strategies of action." Two models of cultural influence are developed, for settled and unsettled cultural periods. In settled periods, culture independently influences action, but only by providing resources from which people can construct diverse lines of action. In unsettled cultural periods, explicit ideologies directly govern action, but structural opportunities for action determine which among competing ideologies survive in the long run. This alternative view of culture offers new opportunities for systematic, differentiated arguments about culture's causal role in shaping action. The reigning model used to understand culture's effects on action is fundamentally misleading. It assumes that culture shapes action by supplying ultimate ends or values toward which action is directed, thus making values the central causal element of culture. This paper analyzes the conceptual difficulties into which this traditional view of culture leads and offers an alternative model. Among sociologists and anthropologists, debate has raged for several academic generations over defining the term "culture." Since the seminal work of Clifford Geertz (1973a), the older definition of culture as the entire way of life of a people, including their technology and material artifacts, or that (associated with the name of Ward Goodenough) as everything one would need to know to become a functioning member of a society, have been displaced in favor of defining culture as the publicly available symbolic forms through which people experience and express meaning (see Keesing, 1974). For purposes of this paper, culture consists of such symbolic vehicles of meaning, including beliefs, ritual practices, art forms, and ceremonies, as well as informal cultural practices such as language, gossip, stories, and rituals of daily life. These symbolic forms are the means through which "social processes of sharing modes of behavior and outlook within [a] community" (Hannerz, 1969:184) take place.
6,869 citations
TL;DR: The authors provides an overview of recent developments in historical institutionalism and assesses the progress in understanding institutional formation and change, drawing on insights from recent historical institutional work on icritical juncturesi and on ipolicy feedbacks.
Abstract: This article provides an overview of recent developments in historical institutionalism. First, it reviews some distinctions that are commonly drawn between the ihistoricali and the irational choicei variants of institutionalism and shows that there are more points of tangency than typically assumed. However, differences remain in how scholars in the two traditions approach empirical problems. The contrast of rational choiceis emphasis on institutions as coordination mechanisms that generate or sustain equilibria versus historical institutionalismis emphasis on how institutions emerge from and are embedded in concrete temporal processes serves as the foundation for the second half of the essay, which assesses our progress in understanding institutional formation and change. Drawing on insights from recent historical institutional work on icritical juncturesi and on ipolicy feedbacks,i the article proposes a way of thinking about institutional evolution and path dependency that provides an alternative to equilibrium and other approaches that separate the analysis of institutional stability from that of institutional change.
4,425 citations
TL;DR: In this article, the authors study the evolution of the constitutional arrangements in seventeenth-century England following the Glorious Revolution of 1688 and argue that the new institutions allowed the government to commit credibly to upholding property rights.
Abstract: The article studies the evolution of the constitutional arrangements in seventeenth-century England following the Glorious Revolution of 1688. It focuses on the relationship between institutions and the behavior of the government and interprets the institutional changes on the basis of the goals of the winners—secure property rights, protection of their wealth, and the elimination of confiscatory government. We argue that the new institutions allowed the government to commit credibly to upholding property rights. Their success was remarkable, as the evidence from capital markets shows.
4,267 citations