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Cooperation and Coordination in the Implementation of Social Public Policies: The Case of Health Policy


This article compares the degree of implementation of healthcare regionalization in Brazil based on an in-depth study on a sample of states. The management of social policies in the federal context is considered to create a need for combining autonomy and cooperation among federated bodies, leading to the age-old challenge of collective action. Although the nationally-defined institutional regulations favor cooperation, they are unable to account for the variations between the federal units. To interpret these differences, a regression model was built identifying explanatory factors across two levels, with structural factors considered on a municipal level (resources that affect the ability to provide healthcare services) and the role played by the state as a coordinator or facilitator of cooperation on a second level. Both structural factors and the role played on a state level exert important effects on regionalization, with federal incentives unable to guarantee complete adhesion by federal bodies, nor the elimination of structural obstacles.

regionalization; health; federalism; cooperation; coordination

Instituto de Estudos Sociais e Políticos (IESP) da Universidade do Estado do Rio de Janeiro (UERJ) R. da Matriz, 82, Botafogo, 22260-100 Rio de Janeiro RJ Brazil, Tel. (55 21) 2266-8300, Fax: (55 21) 2266-8345 - Rio de Janeiro - RJ - Brazil