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

Telma Menicucci Alisson Maciel de Faria Marques About the authors


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