Health Policy and Planning, Vol 14, 115-126, Copyright © 1999 by Oxford University Press
A Glassman, M Reich, K Laserson and F Rojas
This article examines the major political challenges associated with the
adoption of health reform proposals, through the experience of one country,
the Dominican Republic. The article briefly presents the problems of the
health sector in the Dominican Republic, and the health reform efforts that
were initiated in 1995. The PolicyMaker method of
applied political analysis is described, and the results of its application
in the Dominican Republic are presented, including analysis of the policy
content of the health reform, and assessment of five key groups of players
(public sector, private sector, unions, political parties, and other
non-governmental organizations). The PolicyMaker
exercise was conducted in collaboration with the national Office of
Technical Coordination (OCT) for health reform, and produced a set of 11
political strategies to promote the health reform effect in the Dominican
Republic. These strategies were partially implemented by the OCT, but were
insufficient to overcome political obstacles to the reform by late 1997.
The conclusion presents six factors that affect the pace and political
feasibility of health reform proposals, with examples from the case of the
Dominican Republic.
ARTICLES
Political analysis of health reform in the Dominican Republic
Inter-American Development Bank, Washington, DC, USA; Harvard School of Public Health, Boston, MA, USA; US Public Health Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Medical Doctor, Dominican Republic
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