Gaining public control on health policy: the politics of scaling up to universal health coverage in Uruguay

Abstract

This study presents the health reform in Uruguay as an example of a country successfully gaining control over health policy and scaling up toward universal health coverage through a national insurance model. The study looks at the circumstances leading to the opening of the policy window and to the politics that made the passage of the reform possible. Evidence is mainly qualitative. The main findings relate to the role the state can play as an intelligent regulator and coordinator; the trade-off facing the governments since consolidating the private and third sector providers can strengthen the opposition to future policy changes; how medical and economic interests do not oppose reforms that preserve their autonomy, and how trade unions will not oppose reforms that simultaneously improve investment and working conditions in the public provider.