The political economy of health services provision and access in Brazil

The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains access to health services when he, or she seeks it. The authors find that an increase in income inequality, an increase in the percentage of the population that votes, and an increase in the percentage of votes going to left-leaning candidates are each associated with higher levels of public health services. The per capita provision of doctors, nurses, and clinics is also greater in counties with a popular local leader, and in counties where the county mayor and state governor are politically aligned. Administrative decentralization of health services to the county decreases provision levels, and reduces access to services by the uninsured, unless it is accompanied by good local governance.Health Systems Development&Reform,Health Monitoring&Evaluation,Public Health Promotion,Regional Rural Development,Gender and Health,Health Economics&Finance,Health Monitoring&Evaluation,Health Systems Development&Reform,Regional Rural Development,Gender and Health

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1069/thumbnail.jp

An Institutional Approach to Donor Control: From Dyadic Ties to a Field‐Level Analysis

Literature on the nonprofit sector focuses on charities and their interactions with clients or governmental agencies; donors are studied less often. Studies on philanthropy do examine donors but tend to focus on microlevel factors to explain their behavior. This study, in contrast, draws on institutional theory to show that macrolevel factors affect donor behavior. It also extends the institutional framework by examining the field‐level configurations in which donors and fundraisers are embedded. Employing the case of workplace charity, this new model highlights how the composition of the organizational field structures fundraisers and donors alike, shaping fundraisers’ strategies of solicitation and, therefore, the extent of donor control.This research was supported by grants from the Aspen Institute’s Nonprofit Sector Research Fund and the National Science Foundation. I thank Susan Eckstein, Julian Go, Heather MacIndoe, Susan Ostrander, audiences in the departments of sociology at Boston University, Emory University, Ohio State University, University of Arizona, and the University of Chicago, various participants in the University of Chicago Graduate School of Business Organizations and Markets Workshop and the MIT‐Sloan School of Management Organization Studies Group Seminar Series, and AJS reviewers for helpful comments on earlier versions. Direct correspondence to Emily Barman, Deparment of Sociology, Boston University, 96 Cummington Street, Boston, Massachusetts 02115