Changes in the governance of a centenary social state: structure and operation of the Integrated National Health System of Uruguay

Abstract

This article discusses the creation of the National Integrated Health System (SNIS) during the administrations of the Frente Amplio. Its focus is the new institutions that created the health sector reform, including the institutional mechanisms that structure the new sectoral governance. Public-private
provision, the extension of public funding, the creation of devices to guarantee the access to services, were jointly established by the reform. Comparatively speaking, this new architecture combines aspects of different worlds of welfare and health systems organization. The reform, which was moderated by a path dependent process, ends up modeling a new kind of state that offers interesting prospects for other areas of welfare service organization.