An n following a page number indicates a note; a t following a page number indicates a table. Abusada, Roberto, 92, 98, 99 Acci ó n Popular (AP; Peru), 91 92, 93, 94, 95 Administradoras de R é gimen Subsidiado, 122 agenda setters, technocrats as, 5, 22, 35 agents of business perspective, 28 33 limitations, 30 33 autonomy in social policy sectors, 33 relationships of subordination, 30 33 private sector work experience before appointment, 30 strong structural perspective, 29 weak structural perspective, 29 30 agents of international financial institutions (IFIs) perspective, 25 28 initial appointments, 28 limitations, 26 28 persistence of autonomy over time, 27 28 relationships of subordination, 26 27 use of leverage, 26 use of linkages, 25 26 Aguinaga, Alejandro, 142 Ahumada, Consuelo, 74 Alfonsin, Ra ú l, 157 158 Alliance for Progress, 68 Alva Orlandini, Javier, 95, 95n1, 96, 96n3 ANAPO (Colombia), 117 ANC (National Association of Coffee Growers; Colombia), 30 ANDI (Asociaci ó n Nacional de Empresarios de Colombia), 30, 84 85 AP ( Acci ó n Popular; Peru), 91 92, 93, 94, 95 APOYO (Colombia), 165 APRA (Peru), 96 97, 102 103, 107, 136 Arce, Mois é s, 29 30 Arenas, Roberto, 84 Arg á ez, Carlos Caballero, 69, 80n10 Argentina fall of economic experts in, 12, 156, 157 158, 159, 160 financial crisis in, 157, 159 importance of technocrats in, 154 market reform in, 157 reduction of technical autonomy in, 62 Asociaci ó n Bancaria y de Entidades Financieras de Colombia (ASOBANCARIA), 84 85 Asociaci ó n Colombiana de Hospitales y Cl í nicas (ACHC; Association of Health Providers), 129 Asociaci ó n Nacional de Empresarios de Colombia (ANDI), 30, 84 85 Asociaci ó n Nacional de Instituciones Financieras (ANIF; Association of Financial Institutions; Colombia), 84 85 authoritarian regimes bureaucratic authoritarianism, 3 historical association of technocrats with, 3, 165 semi-authoritarian regimes, 3 in Venezuela, 160 autonomy of technocrats, overview of, 4 5 expertise as main source of, 5, 112 factors in variation in strength of, 5 9, 6t1.1 limitations to, 9 and politics of policy factors, 6 8, 10t1.2 constellation of stakeholders, 7 8, 10t1.2 cost of bad policy performance, 6 7, 10t1.2 193
194 autonomy of technocrats, overview of (cont.) strength in policy sector, 5 and technical aspects of policy, 8, 10t1.2 expert consensus, 8, 10t1.2 policy complexity, 8, 10t1.2. See also technocratic autonomy theory Baca Campod ó nico, Jorge, 100 Bachelet, Michele, 154 155 Banco de la Rep ú blica (Central Bank; Colombia) education requirements for technocrats, 78 Monetary Board of, 32, 68, 76 as research center, 79 scholarship programs for technocrats, 78 separate interest rate for coffee industry, 74 technical excellence of, 65 banking sector, 155 Banzer, Hugo, 158 Barco, Victor Ren á n, 72 Barco, Virgilio, 65, 73, 75 Barnett, Michael N., 37 Bates, Robert, 28 Bela ú nde, Fernando, 32, 90 93 Berm ú dez, Francisco Morales, 91 Bersh, David, 116 Betancourt, Belisario, 73 Betancur, Belisario, 65 Biglaiser, Glen, 40 Bolivia fall of economic experts in, 12, 156, 158 160 importance of technocrats in, 154, 155 macroeconomic policy in, 159n3 politicization of Bolivian Ministry of Economics, 62 Bolivian Revolution, 159 Bolo ñ a, Carlos, 98, 99, 100, 108, 109, 138 Botero, Rodrigo, 32, 69, 77, 80n10, 86 87, 88 Brazil cash transfer program in, 102 importance of technocrats in, 3, 154 Brint, Steven, 4n3 bureaucratic authoritarianism, 3 bureaucratic independence, 37n1 bureaucratic reform, in Peru, 98 business interests agents of business perspective, 28 33 in Chile, influence of coalitions, 29, 29n5 in Colombia and insulation of economic policy making, 76 and technical autonomy in Colombia, 74 technocrat-business relationship, 31 32 defining, 25n3 instrumentalist theory on, 30 33 in Peru appointment of pro-business technocrats, 104 105 career path of technocrats closely linked to, 103 104 disagreements with neo-liberal technocrats, 104 increased power of business sector in Peru, 62 and insulation economic policy making, 104 opposition to reforms in 1980s, 95 privatization of state enterprises, 93, 98, 99 technocrat-business relationship, 32 33 technocratic autonomy theory on, 50 and technocratic continuity, 61. See also stakeholders Cajas de Compensaci ó n Familiar (special insurance systems; Colombia), 117 Camet, Jorge, 99, 100 Carbone, Fernando, 143 C á rdenas, Mauricio, 80n10 Cardoso, Fernando Henrique, 155 caretaker governments, 100, 157 Carranza, Luis, 101, 110 Carrasquilla, Alberto, 82 83, 85 Castilla, Luis Miguel, 104 105, 110 Cavallo, Domingo, 157, 160 Central Bank. See Banco de la Rep ú blica (Central Bank ; Colombia) Central Bank (Peru), 103 Centro de Estudios sobre Desarrollo Econ ó mico (CEDE; Colombia), 79, 86 Centro de Investigaci ó n de la Universidad del Pac í fico (CIUP; Peru), 103, 113, 165 Ch á vez, Hugo, 160 161 Chicago Boys (Chile), 3, 154 Chile importance of technocrats in, 3, 154 155 powerful business coalitions under Pinochet, 29, 29n5 Chilean health reform model, 138, 149 cholera epidemic, 138 Christian Democrats (Chile), 154 CIEPLAN monks, 154
195 CIUP ( Centro de Investigaci ó n de la Universidad del Pac í fico; Peru), 103, 113, 165 CLAS, 144 clientelism in Colombia, 71 73, 127 in Venezuela, 160 coffee industry (Colombia), 74, 75, 87 Collier, David, 13 14 Colombia, 11, 12 active role of technocrats in, 41 coffee industry in, 74, 75, 87 contrast with Peru economic case, 112 113 discretionary funds for congressman in exchange for reform, 69n4 economic continuity in, 9, 166 167 economic crisis in, 22 23, 28 economic elites in, 29 economic officials in, 70t4.1 export-oriented reform in, 32 first international mission of World Bank to, 68n1 increase in importance of technocrats in, 3 industrial sector in, 32 institution building in, 164 market reform in, 31, 75 76, 88 payoffs for institution building in, 164 reform of executive in, 68 second generation reforms under Gaviria, 119 technical complexity of economic sector in, 55 technical consensus since National Front, 57 58 technocrat-business relationship, 31 32 technocrat-ifi relationship in, 26 types of government in, 14. See also economic technocrats in Colombia ; health technocrats in Colombia Colombian Association of Health Purchaser Companies ( Asociaci ó n Colombiana de Empresas de Medicina Integral, ACEMI; Colombia), 129 Colombian Medical Federation, 120 121 Comisi ó n de Regulaci ó n en Salud (CRES; Colombia), 130 commerce sector, 155 commercial law reform, in Peru, 98 Conaghan, Catherine, 101n6 Concertaci ó n (Chile), 154 155 conditional loans, 24, 92, 106 CONFIEP (Peru), 30 CONPES ( Consejo Nacional de Pol í tica Econ ó mica y Social; Colombia), 68, 69 Consejo Gremial (Colombia), 84 85 Consejo Nacional de Pol í tica Econ ó mica y Planeaci ó n (Colombia), 67 68 Consejo Nacional de Pol í tica Econ ó mica y Social (CONPES; Colombia), 68, 69 Consejo Nacional de Seguridad Social en Salud (National Council for Social Security in Health; Colombia), 122 constellation of stakeholders. See stakeholders Constitutional Court (Colombia), 124, 127 128 Constitution of Peru, 1979, 91 corruption in Colombia, 127 in Peru, 100, 137, 143 Costa Bauer, Marino, 141 142 Costa Rica, 155 Council of Ministers (Peru), 107 crawling peg exchange rate, 69 70 CRES (Comisi ó n de Regulaci ó n en Salud; Colombia), 130 crisis, appointment of experts during, 38, 43 cross-temporal analysis vs. static approach, 12 Currie, Lauchlin, 84 de Habich, Midori, 143 de la R ú a, Fernando, 157 democracies, and technocrats, 165 168 economic technocrats, 166 167 health technocrats, 166 and patronage politics, 167 power over politicians, 165 166 responsiveness to citizen demands, 167 role in connecting centers of knowledge with state, 168 role in initiating reforms, 167 democracy, defining, 14, 16 dependency theory, and external agents perspective, 25 devaluation, in Colombia, 31, 68, 69 70, 74 Direcci ó n de Cr é dito P ú blico (Directorate of Public Credit), 72 73 domestic structural perspective, 162 Duhalde, Eduardo, 157 158, 159, 160 Durand, Francisco, 30 Echavarr í a, Juan Jos é, 80n10 Echeverry, Juan Carlos, 71, 72, 79n8
196 economic crisis in Argentina, 157, 159 in Colombia, 22 23, 28, 68, 124 instrumentalist theory on, 21 23 in Mexico, 21 22 in Peru, 21 23, 28, 93, 97, 137 economic journals, peer reviewed, 79n9 economic technocrats in Colombia, 1958 2013, 9, 17 business actors, alleged power of, 73 76 and information asymmetry, 74 and insulation from business/political interests, 76 and market reform, 75 76 and policy preferences vs. economic forces, 74 and structural changes in economy, 74 75 clientelism, 71 73 and lack of rationalism of politicians, 72 73 and limiting political control over resources, 72 and restraints on incumbents, 73 determinants of autonomy of, 81 88 business associations, 84 86 complexity of economic policy, 86 87 consensus among experts, 87 88 constellation of stakeholders, 83 86 cost of bad policy performance, 81 83 IFIs, 84 political parties, 83 84 politics of policy factors, 81 86 technical aspects of policy factors, 81, 86 88 and devaluation, 1985, 31 emergence/continuity of, factors in, 65 71 appointments to Monetary Board, 70 71, 71t4.2 arguments for continuity, 70, 70t4.1 balance-of-payments crises and IMF, 68 budget reform, 67 Central Bank reform, 67 creation of development investment council, 67 68 domestic reform role in, 67 68 exchange rate, 69 70 external leverage role in, 68 first generation of technocrats, 69 international linkages, 68 NF pact, 66 67 patronage politics, 67 promotion of non-traditional exports, 68 69 recruitment process/informal career track, 71 reforms under Lleras Camargo, 67, 68 reforms under Lleras Restrepo, 69 70 reforms under Michelsen, 70 reforms under Pastrana, 70 reforms under Valencia, 68 role of Congress in, 68, 69, 72 strengthening of CONPES, 69 strengthening of NPD, 69 and market reform, 31, 75 76 and non-traditional exports, 74 75 strategies to maintain autonomy, 77 81 institutionalization, 77, 78 scholarship programs, 78 79 strong epistemic community in economics, 79 80 technical knowledge requirement for policy making, 77, 78 technocrat-business relationship, 31 economic technocrats in Peru, 17 in 1980s, 91 97, 154 and business groups lack of consensus, 96 and business opposition to reforms, 95 and constellation of stakeholders, 52, 94 95, 154 and IFIs support of reforms, 94 and lack of technical consensus, 94, 95 97 and obstacles to carrying out reforms, 92 93 and political costs of bad decisions, 94, 154 and political opposition to reforms, 95 and political parties lack of consensus, 96 and politics of policy factors, 94 95, 154 reasons for downfall of technocrats, 94 97 and reform of ISI model, 91 92 and successful reforms, 93 and Team Dynamo/MEF, 91 97 autonomy, reasons for, 105 112 constellation of stakeholders, 109 111 determinants in MEF, 107 112 IFIs role, 106 implementation of market reforms, 106 negative political consequences, 107 109 parliamentary coordination, 106 political intervention in economic policy, 106 107 politics of policy factors, 107 111 spending ministries, 107
197 strategic actions in MEF after fall of Fujimori, 105 107 technical aspects of policy factors, 111 112 technical complexity, 111 technical consensus, 111 112 and campaign promises, 166 economic ministers (1980 2013), 101t5.1 rise/consolidation of neo-liberal (1990 2013), factors in, 97 105 autonomy, 9 business interests, 99, 103 105 under Fujimori, 98 100 IFIs, 98 99 increased power of business sector, 62 institutional reforms, 98 market reforms, 98 99 military ministers, 99 100 political insulation, 99, 101 103 education sectors, and technocrat autonomy, 155 El Comercio (Peru), 109 electoral incentives theory, and information asymmetry, 38 El Libano, 118 El Salvador, importance of technocrats in, 154 El Tiempo, 128 emp í ricos, 86 Empresas Prestadoras de Salud (EPS; Colombia), 121, 130 Empresas Prestadoras de Salud (EPS; Peru), 142, 149 entrenchment, defining, 4 epidemics, 46, 138, 150, 151 epistemic community in Colombia, 79 80 defining, 55 56 specifications of, 56n6 EPS ( Empresas Prestadoras de Salud; Colombia), 121, 130 EPS ( Empresas Prestadoras de Salud; Peru), 142, 149 Equipo Cambio (Team Change; Colombia), 120 122, 123 124, 126, 128, 131 Escuela Nacional de Administraci ó n (Colombia), 67 Estrada Á lvarez, Jairo, 29, 73 exchange rate, crawling peg in Columbia, 69 70. See also devaluation exports and Colombia export-oriented reform in, 32 non-traditional exports, 68 69, 74 75 overdependence on coffee exports, 87 and Peru export-oriented economy, 98 subsidies for non-traditional exports, 93 external agents perspective, 25 external structural perspective, 162 family planning in Colombia, 117 in Peru, 143 Federaci ó n Nacional de Cafeteros (Colombia), 84 85 Fedesarrollo ( Fundaci ó n para la Educaci ó n Superior y el Desarrollo; Colombia), 41, 71, 79 80, 116, 126 Ferrero, Carlos, 102n7 financial crisis. See economic crisis Financing Health Services in Developing Countries: An Agenda of Reform (World Bank), 58 Finnemore, Martha, 37 foreign investment, in Peru, 93 French bureaucrats, and information asymmetry, 37 Freundt, Jaime, 138 Fujimori, Alberto commitment to economic continuity, 3, 108, 109 corruption scandal, 14, 100 and economic crisis, 98 100 free insurance program for students, 142, 145, 146, 147, 148 and health reform, 134, 137 143 and MEF, 90 and pension reform, 106 functional perspective, on importance of technocrats, 20 Fundaci ó n para la Educaci ó n Superior y el Desarrollo (Fedesarrollo; Colombia), 41, 71, 79 80, 116, 126 Gal á n Sarmiento, Augusto, 131 Garc í a, Alan and cash transfer program, 102 and economic continuity, 1 2, 166 and economic crisis, 107 108 failed reform by Tejada under, 136 137 new economic development model of, 96 97 and SNIP, 102, 103 technical commitment of, 101, 108, 109 110
198 Gaviria, Alejandro, and health reform, 38, 47, 121, 124, 128 129, 132 Gaviria, C é sar, 65, 73, 75 76 Geddes, Barbara, 21, 49n4, 56, 162 163 Goldenberg, Isaac, 100 G ó mez, H é ctor Abad, 116 G ó mez, Hernando, 69 Gray Molina, Fernando, 158 Grindle, Merilee, 40 Grupo de Analisis para el Desarrollo (GRADE; Peru), 103, 113, 165 Guti é rrez, É dgar, 69 Haas, Peter M., 38 Harvard Group, 122 123 Harvard Report, 122 Harvard School of Public Health, 126, 129 Harvard Team, 126 health insurance, private, 117, 119 120, 129 130, 138 Health Promoting Enterprises ( Empresas Promotoras de Salud, EPS; Colombia), 121 health sector health expert-ifi relationship in, 27 lack of politician awareness of complexity of reforms, 24 patronage resources, 46 policy feedback, 46 primary health care, emergence of, 58 private health insurance, 117, 119 120, 129 130, 138 resource limitations, 59 selective primary health care, emergence of, 58 technical autonomy in, 9, 23 universal policies, shortcomings of, 58 and upper and middle classes, 46. See also health technocrats in Colombia ; health technocrats in Peru Health Service Providers ( Instituciones Prestadoras de Servicios, IPS; Colombia), 121 Health Social Security ( Seguro Social de Salud, ESSALUD; Peru), 135 health technocrats, lack of power, 2 health technocrats in Colombia, 17 18 in 1958 1974 (during National Front), 114, 115 119 constellation of stakeholders, 118 family planning campaigns, 117 funding, 117, 118 growing complexity of health system, 124 health expenditures, 116 health facility building, 117 health reforms, 116 117 insurance programs, 115, 117 national health plan, 116 policy under Lleras Restrepo, 116 117 political costs of bad health policy, 117 politics of policy factors, 117 118 public health experts at Ministry of Health, 116 resource allocation, 116 sewage infrastructure, 117 technical aspects policy factors, 118 technical complexity, 118 technical consensus, 118 vaccinations, 117 in 1993 2013, 114, 119 changes under Samper, 123 continuity after government change, 122 123 contribution-based regime, 121, 122 criticism of Ley 100, 132 expansion of coverage, 121 Harvard Group, 122 123 health ministry approach, 120 increased leverage and saliency of experts, 121 122 increased political cost of bad health policy in, 46 Ley 100, 121 122, 131 policy under Santos, 124 policy under Uribe, 123 124 primary health care approach, 119, 120 private participation approach, 119 120 reforms created new stakeholders, 62 reform under Gaviria, 119 120 subsidized regime, 121, 122 Team Change (Equipo Cambio), 120 122, 123 124, 126, 128, 131 autonomy and continuity of, factors in, 125 132 alliances with domestic/foreign actors as strategy for, 126 clientelism and corruption, 127 constellation of stakeholders, 125, 128 130, 154 creation of semi-autonomous offices as strategy for, 126 financial crisis effect on, 124 growth of subsidized system, 127 health system institutions, 131
199 IFIs, 128 129 information asymmetry, 126 patients and civic groups, 130 persistent autonomy over time, 27, 33 policy complexity, 115, 125, 130 131 political costs of bad policy performance, 125, 127 128, 154 politician dependence on experts, 131 politics of policy factors, 127 130 private health insurers/providers, 129 130 technical aspects of policy factors, 130 132 technical consensus, 125, 131 132 three strategies for building autonomy, 125 126 contrast with Peru, 144, 147 148, 151 politics of policy factors, 114 115 bad policy performance, 114 115 constellation of stakeholders, 115 present coverage of Colombians, 124 technocrat-ifi relationship, 27, 28 health technocrats in Peru, 18 autonomy of, 33 contrast with Colombia, 144, 147 148, 151 and corruption, 143 current coverage of Peruvians, 135 136 emergence and stability (1990 2002), factors in, 137 143 approval of loans by IFIs and bilateral aid agencies, 139 autonomy from IFIs, 140 141 cholera epidemic, 138 evidence of autonomous action, 140 141 failure to achieve reform in line with preferences, 141 free insurance program for students, 142 under Fujimori, 134, 137 143 under Garc í a, 143 high ministerial/lower level personnel turnover, 140 under Humala, 143 neoliberal health reform project, 138 political insulation, 140 political interventions, 141 142 poverty alleviation campaign, 139 privatization of health care, 141 142 reasons for expansion of autonomy, 138 139 reform plan of Vidal, 137 138, 149n7 reform under OCE, 139 143 resource issues, 142 restructuring of OCE under, 143 technocrats become ministerial advisors, 138 under Toledo, 143 epidemiology office of MINSA, 150, 151 healthcare for poor persons, 140 Health Ministry before reform, 135 137 decentralization of material/human resources, 136 economic crisis and corruption, 137 failed reform by Tejada, 136 137 low level of expertise, 136 responsibilities of, 135 136 IFIs declining interest in reform, 52, 151 lack of politician awareness of technical complexity of reforms, 24 lack of public interest in health policy, 147 148 limited autonomy/eventual demise of, factors in, 134 135, 143 150 complexity of health sector compared with financial sector, 147 constellation of stakeholders, 144, 145 146, 151 decline in influence of technocrats, 141 143 increasing complexity, 144, 146 147, 151 negative factors, 147 150 political cost of bad performance, 144, 147 148, 151 political insulation, 144 145 positive factors, 145 147 secrecy of actions of technocrats, 144 145 technical consensus, 144, 148 149, 151 middle/upper class detachment from health system, 148 MINSA health infrastructure (1980 2002), 141t7.1 persistent autonomy of health experts over time, 27 primary health care, 140, 148 technocrat-ifi relationship in, 27 urban/middle class bias of health system, 140 Hirschman, Albert, 46 Hommes, Rudolph, 72, 75 76, 88 Huber, Evelyne, 48 Humala, Ollanta appointment of pro-business technocrats, 104 105 and cash transfer program, 102
200 Humala, Ollanta (cont.) technical commitment of, 108, 109 110 and technical continuity, 1 2, 90, 101, 166 Hume, Mar í a Jes ú s, 95 Hurtado Miller, Juan Carlos, 98 hyperinflation, 45, 58 in Peru, 105, 112 immunization programs, in Peru, 137, 139 import licenses, eliminated except for agricultural products in Colombia, 75 import substitution industrialization (ISI) model (Colombia), 74, 98 industrial sector in Colombia, 32 in Peru, 32, 109 infant care, in Peru, 140 information asymmetry, 37 38, 39 in Colombia, 74, 77, 78, 126 and electoral incentives theory, 38 and international organizations, 37 and principal-agent theory, 37 infrastructure projects in Colombia, 117, 118 in Peru, 91 92, 93, 104 input side of politics, 15 Institute of Social Security (Peru), 149 institutionalization, and technocratic autonomy in Colombia, 77, 78 institution building in Colombia, 164 in Peru, 98, 164 165 significant payoffs for, 164 165 as source of technocratic autonomy, 41 Instituto de Seguridad Social (ISS; Colombia), 115, 117, 118 instrumentalist theory, 19 agents of business perspective, 28 33 agents of international financial institutions perspective, 25 28 limitations, 3 4, 33 34 political agents perspectives, 20 24 Inter-American Development Bank (IDB) courses and conferences by, 26 and health reform in Colombia, 129 and health reform in Peru, 139, 142, 145 International Cooperation Office ( Oficina de Cooperaci ó n Externa, OCE; Peru), 134, 137, 138, 139 143 international financial institutions (IFIs) agents of international financial institutions perspective, 25 28 and economic reform in Colombia, 68, 76 and health reform in Colombia, 27, 116, 118, 129 and health reform in Peru, 27, 136, 139, 141, 142, 145, 148, 150, 151 and limits to borrowing in Peru, 93 as stakeholders, 50n5 and technocratic continuity, 61. See also Inter-American Development Bank (IDB) ; International Monetary Fund (IMF) ; World Bank (WB) ; World Health Organization (WHO) International Monetary Fund (IMF), and balance-of-payments crisis in Colombia, 68 international organizations, and information asymmetry, 37 IPSS ( Instituto Peruano de Seguridad Social, Peruvian Social Security Institute), 135 Islands of Efficiency (MINSA), 143 ISS ( Instituto de Seguridad Social; Colombia), 115, 117, 118 Izquierda Unida (United Left; Peru), 96 Izquierdo, Jorge Gonz á lez, 92 Japanese cooperation agency (OECF), 139 jargon, technical, 54 Jensen, Brian, 92 Johns Hopkins University, 150 Joy Way, V í ctor, 100, 110 111 judicial autonomy, pluralist theory on, 48 Junguito, Roberto, 69, 72, 80n10, 85 Kirchner, Cristina Fernandez de, 62, 158, 160 Kirchner, N é stor, 62, 158, 159, 160 Krueger, Anne O., 28 Kuczynski, Pedro Pablo, 1, 102, 103 104 labor sectors, and technocrat autonomy, 155 labor unions, 45, 46 Lagos, Ricardo, 154 155 Lara, Jorge Ru í z, 69, 83 Latin America, economic technocrats in early history of, 3 fall of experts (other than Peru/Colombia), 155 156 in Argentina, 156, 157 158, 159, 160 in Bolivia, 156, 158 160 politics of policy factors, 156 constellation of stakeholders, 156, 159 160
201 political costs of bad decisions, 156, 159 technical factors, 156 lack of technical consensus, 156, 160 in Venezuela, 156 157, 160 161 increase of importance of, 2, 3 Lavagna, Roberto, 157 158, 159, 160 least likely cases, 11 12 Levitsky, Steven, 61 Ley 100 (Colombia), 121 122, 131 contribution-based regime, 121, 122 criticism of, 132 expansion of coverage, 121 subsidized regime, 121, 122 Ley de Modernizaci ó n de la Seguridad Social en Salud (Peru), 144 Ley General de Salud (Peru), 144 Lineamientos de Pol í tica de Salud (1995 2000) (Peru), 141 linkages, 25 26, 68 Lleras Camargo, Alberto control/rationalization of public expenditures under, 67 economic reforms under, 67, 68 increased importance of economic technocrats under, 3 negotiations with IFIs under, 68 use of health experts to advance health reform goals of, 38 Londo ñ o, Beatrice, 124 Londo ñ o, Juan Luis, 114, 120 124, 125 L ó pez Michelsen, Alfonso, 70, 84, 88 Lora, Eduardo, 80n10 M-19 (Colombia), 119, 120 Magaloni, Beatriz, 21 22 Mann, Michael, 49n3 market reform in Argentina, 157 in Chile, 3 in Colombia, 31, 75 76, 88 in Mexico, 3 in Peru, 29 30, 32, 90 91, 106 MAS party (Bolivia), 159 maternal care, in Peru, 140 maternal-infant insurance program ( Seguro Materno-Infantil; Peru), 142 media depiction of Alva Orlandini, 96n3 and second Colombian health episode, 46 use by MEF to deflect political threats, 107 use by technocrats to further own policy, 41 MEF. See Ministry of Economics and Finance (MEF ; Peru) Menem, Carlos, 157 Mesa, Carlos, 158 159 Mexico autonomy of technocrats in, 40 cash transfer program in, 102 importance of technocrats in, 3, 154 and market reform in, 3 neoliberal technocrats in, 21 22 Meynaud, Jean, 37 Minister of Social Protection (Colombia), 123 Ministry of Economics and Finance (MEF; Peru), 1, 23 and basic healthcare for poorest in Peru, 139 and cash transfer program, 102 corruption scandal under Fujimori, 100 and health reform, 27, 142 and hyperinflation and market reform, 90 91 increasing expertise of, 100 101, 101t5.1 and infrastructure improvement, 104 and limitation on public expenditure before 2006 election, 102 and neoliberal health reform project, 138 and neoliberal reforms/infrastructure development, 92 93 Peruvians views of technocrats in, 97 98 political insulation of technocrats, 99, 101 103 politicalization under Alan Garc í a, 96 97 political leverage diminishing after 1993 crisis, 99 reduction of protective tariffs by, 104 and SIAF, 102 and SNIP, 101 102 and tax reform, 104 use of press to deflect political threats, 107 Ministry of Finance (MF; Colombia), 23 education requirements for technocrats, 78 and international loans, 87 technical consensus since National Front, 57 58 technical excellence of, 65 Ministry of Health (Mimsteno de Salud, MINSA; Peru) administrative duties taken over by regions, 135n2 epidemiology office of, 150, 151 under Fujimori, 134 health infrastructure (1980 2002), 141t7.1
202 Ministry of Health (Mimsteno de Salud, MINSA; Peru) (cont.) influence of health technocrats within, 2 Islands of Efficiency, 143 poverty alleviation programs, 146 project budgets, 139n3 before reform, 135 137 decentralization of material and human resources, 136 economic crisis and corruption, 137 failed reform by Tejada, 136 137 low expertise, 136 low level of expertise, 136 responsibilities of, 135 136 Ministry of Social Protection, 123 MINSA. See Ministry of Health (Mimsteno de Salud, MINSA ; Peru) MNR ( Movimiento Nacionalista Revolucionario; Bolivia), 158 Monetary Board (Colombia), 32, 68, 76 Montenegro, Santiago, 83 Morales, Evo, 62, 158, 159 160 more likely cases, 12 Movimiento Nacionalista Revolucionario (MNR; Bolivia), 158 Murillo, Mar í a Victoria, 61 National Association of Coffee Growers (ANC; Colombia), 30 National Council for Social Security in Health ( Consejo Nacional de Seguridad Social en Salud; Colombia), 122 National Federation of Coffee Growers, 86 National Front (NF; Colombia) health experts during, 115 119 restricted electoral competition during, 14 National Front pact (1958 1974); Colombia, 65, 66 67 National Planning Department (NPD; Columbia), 23, 84 education requirements for technocrats, 78 increased power/technical capacity of, 65, 67 institutionalization of, 78 as research center, 79 scholarship programs for technocrats, 78 National Planning Office. See National Planning Department (NPD ; Colombia) National School of Management (Colombia), 76 nongovernmental agencies (NGOs), and health reform in Peru, 146 North, Douglass, 7, 61 NPD. See National Planning Department (NPD ; Colombia) Ocampo, Jos é Antonio, 80n10, 88 OCE ( Oficina de Cooperaci ó n Externa (International Cooperation Office; Peru), 134, 137, 138, 139 143 Ochoa, Luis Carlos, 116 O Donnell, Guillermo, 3, 15, 40 OECF (Japanese cooperation agency), 139 Ord óñ ez, Antonio, 114, 116 117 Organizaciones de Servicios de Salud (Peru), 138 OSS project (1991; Peru), 141 142, 149 output side of politics, 15, 161 Pacto de Punto Fijo (Venezuela), 62 Pact of Sitges (Colombia), 67 PAHO. See Pan American Health Organization (PAHO) Palacio, Diego, 123 124 Pan American Health Organization (PAHO) and health reform in Colombia, 27, 118 and health reform in Peru, 27, 137, 141 and preventative health, 116 and selective primary health care, 148 Paniagua, Valentin, commitment to economic stability, 108 110 Paredes, Nelcy, 123 Paredes, Victor, 138 Paris Club, 139 PARS ( Programa de Apoyo a la Reforma en Salud; Colombia), 123, 125, 126 PARSALUD ( Programa de Apoyo a la Reforma de Salud; Peru), 142 Partido dos Trabalhadores (Brazil), 155 Partido Popular Cristiano (PPC; Peru), 92, 96 Partido Revolucionario Institucional (PRI; Mexico) commitment to responsible economic policy, 21 22 and importance of technocrats, 3 and market reform, 3 and technocrat autonomy, 40 Pastrana, Andr é s, 123 Pastrana, Misael, 70, 83 84, 88, 117 patronage politics vs. benefits of collective goods, 21 22 vs. benefits of policy reforms, 21 in Colombia, 67 and democracies, 16 17, 167 and health sector, 46
203 patronage resources, 21, 23, 43 restraints on use of resources, 3 Paz Estenssoro, V í ctor, 158 Paz Zamora, V í ctor, 158 PDVSA (Petrol é os de Venezuela), 62, 156 157, 160 161 pension reform, in Peru, 98, 106, 107, 111 Perry, Guillermo, 69, 80n10, 88 Peru, 11, 12 bureaucratic reform in, 98 career path of technocrats, link to private business, 103 104 contrast with Colombia economic case, 112 113 economic crisis in, 21 23, 28, 93, 97, 137 family planning in, 143 hyperinflation in, 45, 58 immunization programs, in Peru, 137, 139 increased importance of economic technocrats in, 3 industrial sector in, 32 institution building in, 98, 164 165 market reform in, 29 30, 32, 90 91, 106 neoliberal reforms/infrastructure development in, 92 93 pension reform in, 98, 106, 107, 111 poverty alleviation programs in, 146 privatization of state enterprises in, 93, 98, 99 technical complexity of economic sector in, 55 technocrat-business relationship in, 32 33 technocrat-ifi relationship in, 26 27, 28 types of government in, 14 variation in economic policy over time, 57 58. See also economic technocrats in Peru ; health technocrats in Colombia Per ú Posible, 1, 102 103, 107, 143 Peruvian Academy of Health, 149 Peruvian Social Security Institute ( Instituto Peruano de Seguridad Social, IPSS), 135 Petrol é os de Venezuela (PDVSA), 62, 156 157, 160 161 PFSS ( Programa de Fortalecimiento de Servicios de Salud; Peru), 140, 142 Pierson, Paul, 45 Pi ñ era, Sebasti á n, 154 155 Pinilla, Gustavo Rojas, 66, 117 Pinochet, Augusto, 3, 29, 29n5 Plan Obligatorio de Salud (POS; Colombia), 121, 123, 128 pluralist theory, on judicial autonomy, 48 pockets of efficiency, 21, 38 policy makers, practical lessons for, 163 165 levels of success vary across state areas, 163 164 significant payoffs for institution building, 164 165 policy making analysis, limits of electoral incentives/structural theory in, 161 163 political incentive theory, 161 163 structural theory, 162 163 domestic structural perspective, 162 external structural perspective, 162. See also technocratic autonomy theory policy sector, strength of technocrat autonomy in, 5 political agents perspectives, 20 24 on economic abundance and expenditures, 101 and economic crises, 22 23 and good economic times, 23 limitations, 22 24 experts restraint of key political interests, 22 23 explanation for initial appointment of technocrats, 24 politicians ignorance of technical procedures/complex reforms, 23 24 patronage-oriented politics, 21 22 patronage resources, 21, 23 power of appointment/dismissal, 21 reasons to delegate power to technocrats, 20 22 during debt crisis, 21 22 long-term electoral interests, 20 protect foreign investment, 22 political incentive theory, 161 163 Pol í ticas y Plan de Salud 90 95, Polo Democr á tico (Colombia), 132 Pontificia Universidad Cat ó lica del Per ú, 92 POS ( Plan Obligatorio de Salud; Colombia), 121, 123, 128 positive feedback, 45 power of appointment of politicians, 21 power theory, 14 17 and democracies, 15 16 on output side of politics, 15 on variation of capacity, 15 PPC ( Partido Popular Cristiano; Peru), 92, 96 PREC ( Programa de Especializaci ó n en Epidemiolog í a de Campo; Peru), 150
204 press. See media primary health care in Colombia, 119, 120 emergence of, 58 in Peru, 140, 148, 149 selective, 58, 148 principal-agent theory, and information asymmetry, 37 private health insurance in Colombia, 117, 119 120, 129 130 in Peru, 138 privatization of state enterprises, in Peru, 93, 98, 99 pro-business technocrats, 104 105 Programa de Apoyo a la Reforma de Salud (PARSALUD; Peru), 142 Programa de Apoyo a la Reforma en Salud (PARS; Colombia), 123, 125, 126 Programa de Especializaci ó n en Epidemiolog í a de Campo (PREC; Peru), 150 Programa de Fortalecimiento de Servicios de Salud (PFSS; Peru), 140, 142 Programa de Salud y Nutrici ó n B á ica (PSNB and Proyecto 2000; Peru), 139, 140 Programa Juntos (Peru), 102 Programa Salud B á sica para Todos (PSBT; Peru), 139, 144 protective tariffs in Colombia, 75 in Peru, 104 PSBT ( Programa Salud B á sica para Todos; Peru), 139, 144 PSNB and Proyecto 2000 ( Programa de Salud y Nutrici ó n B á ica; Peru), 139, 140 Quiroga, Jorge, 158 rationality of politicians, 72 73 regime types, and technocrats, 165 168 authoritarian regimes, 165 democracies, 165 168 link between, 165 Renjifo, Santiago, 116 research design, present study, 11 13 Restrepo, Carlos Lleras, 3, 65, 69 70, 116 117 revolution from above (1968; Peru), 3 Riesman, David, 48 Rodr í guez, Iv á n, 99 Rodr í guez Pastor, Carlos, 93 Rustow, Dankwart, 48 Salinas, Carlos, 3, 154 Samper, Ernesto, 88 and health reform, 122, 123, 132 and market reform, 88 S á nchez de Lozada, Gonzalo Goni, 158 Santa Mar í a, Mauricio, 71, 124 Santos, Juan Manuel, 65, 128 Schamis, H é ctor, 29 30 Schneider, Ben Ross, 22 scholarship programs for technocrats, 78 79 school insurance program (SEG; Peru), 142, 145, 146, 147, 148 second generation reforms, in Colombia, 119 secrecy, 74, 144 145 Seguro Integral de Salud (SIS; Peru), 135 selective primary health care, 58, 148, 149 semi-authoritarian regimes, 3 sewage systems in Colombia, 117 in Peru, 138 Shining Path (Peru), 18, 93, 97, 139 SIAF ( Sistema Integrado de Administraci ó n Financiera; Peru), 102 Silva, Eduardo, 29n5 Silva Ruete, Javier, 100, 106, 108 109 SIS ( Seguro Integral de Salud; Peru), 135 Sistema Integrado de Administraci ó n Financiera (SIAF; Peru), 102 Sistema Nacional de Inversi ó n P ú blica (National System of Public Investment, SNIP; Peru), 101 102, 103, 111 social legitimacy, 36 37 social policy sectors, and technocrat autonomy, 155 Solari, Luis, 143 special insurance systems ( Cajas de Compensaci ó n Familiar; Colombia), 117 stakeholders defining, 47 48 and fall of economic technocrats in Peru, 94 95, 154 and fall of health technocrats in Peru, 144, 145 146, 151 and fall of technocrats in Latin America (other than Colombia/Peru), 156, 159 160 and health technocrats in Colombia, 62, 115, 118, 125, 128 130, 154 and monitoring of economic appointments in Peru, 109 111
205 plural and balanced constellation of, 7 8, 10t1.2. See also business interests ; international financial institutions (IFIs) ; technocratic autonomy theory Stallings, Barbara, 26 static approach, 12 Steiner, Roberto, 86 strong structural perspective, 29 structural theory, limitations of, 162 163 domestic structural perspective, 162 external structural perspective, 162 SUNAT (Peru), 104 Superintendencia de Salud (Colombia), 130 Superintendencia Financiera (Colombia), 130 tariffs protective in Colombia, 75 protective in Peru, 104 reduction in Colombia, 75 reduction in Peru, 93, 98, 104 tax reform, in Peru, 98, 104 Team Change ( Equipo Cambio; Colombia), 120 122, 123 124, 126, 128, 131 Team Dynamo (Peru), 90, 91 97 technocracy, definition of, 16 technocratic autonomy theory active role of experts in securing autonomy, 40 applications to areas in Latin America other than economics/healthcare, 155 156 applications to fall of experts in Latin America, 156 161 applications to Latin America other than Peru and Colombia, 154 155 conclusions, 63 consensus among experts, 55 60, 57t3.4, 153 as constraint on appointments by politicians, 56 determining consensus levels, 56 57 effects of lack of consensus, 56 explains variation in economic sector, 57 58 explains variation in health sector, 58 59 constellation of stakeholders, 47 53, 51t3.2, 152 153 continuity of autonomy in economic sector, 50 51 effective strategies to advance preferences, 52 53 and health sector, 50, 51 52 political opposition, 49 50 socioeconomic interests/international actors, 50 determinants of technical autonomy, 42 60 expertise as source of autonomy, 36 42, 152 alliance building strategy, 41 diversion of political/socioeconomic pressures from policy areas, 40 41 effectiveness as political resource, 36 37 exclusion of actors without technical training strategy, 40 four strategies to maintain and strengthen influence, 40 41 institution building strategy, 41 leverage expertise provides to its user, 37 38 scarcity of professional politicians, 39 short tenure in office of ministers, effect on, 39 technical asymmetry, 39 health vs. economic technocrats, 153 154 political cost of bad policy performance, 43 47, 44t3.1, 152 153 during crisis, 44 45 decisions affecting larger number of population, 44 and economic sector, 45 and health sector, 46 patronage resources, 43 severity of potential damage, 44 and upper and middle classes, 44, 45 46 visibility/traceability of potential consequences, 44 politics of policy factors, 42 53, 152 153 technical aspects of policy, 53 60, 153 as not as important as politics of policy, 60 technical complexity, 53 55, 54t3.3, 153 of economic policy, 54, 55 of health policy, 55 and types of knowledge, 54 variation in agency capacity, 155 156 variation in degree of autonomy across policy areas, 152 153 variation of technical autonomy across time/ policy areas, 41 42, 152 vulnerability of technical autonomy, 42, 60 63 and constellation of stakeholders, 61, 62 and political costs of bad policy performance, 61, 62 technocratic democracies, defining, 2
206 technocrats, overview of as agenda setters, 5, 22, 35 alliances of, 40 defining, 13 14 policy preferences, advancing, 5. See also autonomy of technocrats, overview of ; technocratic autonomy theory Teichman, Judith, 30 Tejada, David, 136 137, 149n7 textile industry, in Peru, 104 think tanks in Colombia, 41, 71, 79 80, 116, 126 influence of, 80n10 in Peru, 103, 146, 151 Toledo, Alejandro, 100 101 and cash transfer program, 102 and limitation on public expenditure before 2006 election, 102 and public sector salary increases, 103 silent opposition to, 1 and SNIP, 102 technical commitment of, 108, 109 110 Tono, Teresa, 131 tuberculosis (TB) program, in Peru, 137, 139 Turbay Ayala, C é sar, 65, 73, 81 82 Ugarte, Ó scar, 143 Ulloa, Manuel, 91, 92, 93 UNICEF, 118, 148 Unidad Nacional (Peru), 107 unions, 45, 46 United Left ( Izquierda Unida; Peru), 96 United Nations Population Fund (UNFP) and health reform in Colombia, 27 and health reform in Peru, 27, 141 Universidad Cayetano Heredia (Peru), 137 Universidad de Los Andes (Colombia), 71, 79, 86 University of Alabama, 137 Uribe, Á lvaro and health reform, 123 124, 127 128 importance of stakeholders to, 85 86 and political costs of economic policy, 82 83 technical experts under, 65 66, 73, 81 Urrutia, Miguel, 69, 71 72, 80n10 USAID and health reform in Peru, 139, 150 and health spending in Colombia, 116, 118 vaccination program, in Peru, 117 Valencia, Guillermo Le ó n, 68 Vargas Llosa, Mario, 98 Velasco Alvarado, Juan, 91 Venezuela clientelism in, 160 fall of technocrats in state oil company in, 12, 62, 156 157, 160 161 Vidal, Carlos, 137 138, 149n7 weak structural perspective, 29 30 Webb, Richard, 95 Weber, Max, 36, 37, 167 Wiesner, Eduardo, 82 World Bank (WB) courses and conferences by, 26 first international mission to Colombia, 68n1 and health reform in Colombia, 27, 129 and health reform in Peru, 27, 136, 139, 141, 145, 151 limitations of, 164 and restricted selective primary health care, 58 World Development Report: Investing in Health (World Bank), 58 World Health Organization (WHO) and health reform in Colombia, 27 and health reform in Peru, 27, 148 and primary health care, 58 Yamamoto, V í ctor, 138 Yepes, Francisco, 116 Yong Motta, Eduardo, 141 Zavala, Fernando, 102 Zedillo, Ernesto, 3 Zuluaga, Oscar, 85 86