Paradoxical Internationalization: Regulatory Reforms in the Mexican Health‐Care System through the Lens of European Experience

Abstract

Over the recent past, Mexico has been exemplary in having launched regulatory reforms in order to modernize its health-care system, with major objectives being universal insurance coverage and less infrastructural fragmentation. In this article we argue that these reforms, widely inspired by the global New Public Management movement and its aftermath, take shape in a difficult encounter with both the traditional public administration model in Mexico and tensions endemic to the aforementioned reform movement as attempts to enhance system integration coincide with procedural disorganization. This results in a paradoxical internationalization of the Mexican health-care system due to which the above objectives may be difficult to achieve. To illustrate our argument, we examine the Mexican case through the lens of experience two European countries (Germany and Norway) in which reforms have affected the health-care system in a similar way.

Coordination and crisis management. The case of the federal Government and two sub-national governments in Mexico

“…Thus, by combining crisis management approach with perspectives on coordination the study shows the role of subnational governments in dealing with crisis. The study also reveals the potential of crisis management and organization theory approaches to study health policies (Bode and Culebro, 2018) and those related to pandemic crisis, in which vertical and horizontal coordination co-exist in different political systems, either in comparative studies or at subnational level (Liu et al, 2021).…”

“…One way of observing this issue is to reflect about the nature of coordination to face a crisis, for example by including different coordination instruments depending on the stages of the crisis. Under the new institutionalism approach the article highlights the importance of the features of the political-administrative system in Mexico for the first responses of the federal government, if these responses influence subsequent policies (Bode and Culebro, 2018). Similar to the pragmatic approach in crisis management (Boin and Lodge, 2021b) the federal and the subnational governments in México did not impose severe measures that may affect severely mobility or the use of armed forces.…”

“…At a global or national level, health systems are undergoing transformation and depend to a great extent on the historical trajectories of the countries, as well as on the administrative political context in which they are located. In this way, subnational health systems in Mexico are part of a set of institutions characterized not only by their fragmentation both horizontally and vertically, but also by their great inequality between regions and sectors (Bode and Culebro;2018). At the subnational level, health systems replicate, on the one hand, the federal scheme, and on the other, they are capable to design their own organizational schemes.…”

“…The case of México is interesting and has important contributions to the analysis of crisis management as well as policies related to the COVID-19 outbreak. Firstly, because there are few studies have focused on the role of local and subnational governments versus national strategies; and secondly, due to the paradoxical way the coordination instruments in a fragmented system (Bode and Culebro, 2018), the Mexican government confronts the challenge of reducing the impacts of the crisis in a framework of multilevel governance.…”

The Fate of Social Modernity

“…In important respects, moreover, social policy-making has become transnational (Öktem 2020). Non-Western countries strongly involved in international trade often exhibit institutional frameworks and organisational models imported from the Occident, including social security schemes or professionalised human service agencies (see e.g., Bode and Culebro 2018). Hence, at least to some extent, an inspection of the evolving cornerstones of welfare arrangements within Western Europe may contribute to a better understanding of dynamics elsewhere in the world.…”