Are elected officials more responsive to men than women inquiring about access to government services? Women face discrimination in many realms of politics, but evidence is limited on whether such discrimination extends to interactions between women and elected officials. In recent years, several field experiments have examined public officials’ responsiveness. The majority focused on racial bias in the USA, while the few experiments outside the USA were usually single-country studies. We explore gender bias with the first large-scale audit experiment in five countries in Europe (France, Germany, Ireland, Italy, and Netherlands) and six in Latin America (Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay). A citizen alias whose gender is randomized contacts members of parliament about unemployment benefits or healthcare services. The results are surprising. Legislators respond significantly more to women (+3% points), especially in Europe (+4.3% points). In Europe, female legislators in particular reply substantially more to women (+8.4% points).

Latin American welfare states have undergone major changes over the past half century. As of 1980, there were only a handful of countries (Argentina, Brazil, Chile, Costa Rica, and Uruguay) with social policy regimes that covered more than half of their population with some kind of safety net to insure adequate care during their old age and that provided adequate healthcare services. With few exceptions, access to social protection and to healthcare in these countries and others was based on formal employment and contributions from employees and employers. There were very few programs, and those few were poorly funded, for those without formal sector jobs and their dependents. The debt crisis and the ensuing neoliberal reforms then damaged the welfare state in all countries, including these leading nations. Deindustrialization, shrinking of the public sector, and cuts in public expenditures reduced both coverage and quality of transfers and services. Poverty and inequality rose, and the welfare state did little to ameliorate these trends. With the turn of the century, the economic and political situation changed significantly. The commodity boom eased fiscal pressures and made resources available for an increase in public social expenditure. Democracy was more consolidated in the region and civil society had recovered from repression. Left-wing parties began to win elections and take advantage of the fiscal room which allowed for the building of redistributive social programs. The most significant innovation has been expansion of coverage to people in the informal sector and to people with insufficient histories of contributions to social insurance schemes. The overwhelming majority of Latin Americans now have the right to some kind of cash assistance at some point in their lives and to healthcare provided by their governments. In many cases, there have also been real improvements in the generosity of cash assistance, particularly in the case of non-contributory pensions, and in the quality of healthcare services. However, the least progress has been made toward equity. With very few exceptions, new non-contributory programs were added to the traditional contributory ones; severe inequalities continue to exist in the quality of services provided through the new and the traditional programs.

Este artículo presenta un análisis de los principales eventos políticos del 2018. Tras la renuncia de Pedro Pablo Kuczynski (ppk) se dio inicio al primer año de mandato de Martín Vizcarra. Su gobierno enfrentó numerosos escándalos alimentados por el caso Lava Jato, resultando en la detención de políticos clave (incluyendo a los expresidentes ppk y Ollanta Humala) y la transformación de los tres poderes del Estado. Además, una serie de audios destaparon una red de tráfico de influencias dentro del Poder Judicial que involucra la protección de políticos y la negociación de puestos y reducción de penas. Como respuesta, el gobierno de Vizcarra impulsó una serie de reformas institucionales vía referéndum, las cuales se enmarcan en un contexto de precariedad institucional.

The reform approved in Peru in 2009 during a right-wing government deviates from similar attempts in the region to expand access to healthcare. Left-wing parties in Peru were extremely weak during the policy-making process and the political parties were non-programmatic. Based on original field research, this article demonstrates how parties that lacked core values uniting their leaders and had no commitment to the health reform did not care for the definition of specifications regarding funding and implementation. Instead, technocrats dominated the process of policy formation, which, accompanied by the lack of commitment from key political actors, led to poorly specified policy and deficient implementation.

This chapter provides an overview of the development of the public-private mix in healthcare in Mexico, Chile, and Peru. It outlines the development of the private sector in the 1980s and 1990s when the public health systems in all three countries struggled to provide insurance coverage to the majority of their population as well as access to healthcare services. This situation prompted the coexistence of the public and private sectors in a system characterized by fragmentation. One of the main consequences of these fragmented systems is the high out-of-pocket expenditure citizens face. The governments of these countries have sought aid from private providers to guarantee access to healthcare services for their populations. However, the governmental purchase of private services still remains marginal in the three countries. The important role of the private sector in the healthcare systems of Mexico, Chile, and Peru in terms of provision, insurance, and funding resembles a common trend in the Latin American region.