Looking out, working in: How policymakers and experts conceptualize health system models in Argentina, Costa Rica, and Peru

Abstract

Abstract While research has pointed to the role of foreign models in national policy-making we know less about how and why these models are embraced by experts. In this article I examine how experts in Argentina, Costa Rica, and Peru think about foreign models in health: do they compare their countries’ health system to their neighbors’ and other regional countries? Or do they expand beyond their surroundings, looking to those countries with more advanced welfare states and health systems, notably European countries? I focus on which characteristics are salient to experts and policymakers in considering foreign models and how we can account for differences. Drawing from a unique dataset of interviews with national policymakers, civil society actors, consultants, and international organization personnel working in health in Argentina, Costa Rica, and Peru I find that broad political and social concerns, rather than strictly health performance, affect how and whether respondents name foreign models for emulation. In Costa Rica, a country with a strong, universal healthcare system, experts are less willing to rely on foreign models, though they do cite desirable traits abroad. In Argentina, the political structure—its status as a federal state, guides many of experts’ comparisons. In Peru, on the other hand, experts are much more willing to articulate foreign, especially regional, models. I conclude by discussing the importance of considering policymakers’ conceptual frames for understanding policy models and reform in key sectors implicated in development, such as health, especially in the global South.