Infiltrating the State: The evolution of health care reforms in Brazil, 1964-1988

Abstract

The article analyzes the institutional evolution of the health system that resulted in the universalization of coverage and municipalization in the provision of health services in Brazil. I argue that the process of transformation of the relationship between state and society in the context of the authoritarian State facilitated the infiltration of social reformers in the bureaucracy. These activists reoriented the authoritarian health policy by establishing new goals. In considering this case of institutional change, the paper uses a gradualist perspective to understand the institutional developments and alert the specialists of the subject about the inadequacy of the explanations that focus on prioritizing critical junctures or predetermined effects to explain the changes or institutional inertia.