Health care privatization in Latin America: comparing divergent privatization approaches in Chile, Colombia, and Mexico.

The public-private mix in Chile, Colombia, and Mexico was very similar until the early 1980s when Chile undertook health care privatization as part of comprehensive health care reform. Since then, health care privatization policies have diverged in these countries. In this study we characterize health care privatization in Latin America and identify the main factors that promoted and hindered privatization by comparing the experiences of these countries. We argue that policy elites took advantage of specific policy environments and the diffusion of privatization policies to promote health care privatization while political mobilization against privatization, competing policy priorities, weak market and government institutions, and efforts to reach universal health insurance hindered privatization. The privatization approaches of Chile and Colombia were classified as "big-bang," since these countries implemented health care privatization more rapidly and with a wider scope compared with the case of Mexico, which was classified as gradualist, since the privatization path followed by this country adopted a slower pace and became more limited and focalized over time. We conclude that the emphasis on policy-driven privatization diminished in the 1990s and 2000s because of increased public health care financing and a shift in health care reform priorities. Health care privatization in the region, however, continued as a consequence of demand-driven privatization.