Hacia una gobernanza híbrida en salud: perspectivas de investigación sobre la transformación del sistema sanitario costarricense
DOI:
https://doi.org/10.66778/RD.v10ed01.02Palabras clave:
gobernanza híbrida - sistemas de salud - neoinstitucionalismo - teoría de la agencia - políticas públicas - equidad sanitaria - privatización selectiva - universalismo estratificadoResumen
Los sistemas de salud latinoamericanos han experimentado profundas transformaciones en las últimas décadas, transitando desde modelos predominantemente estatales hacia configuraciones híbridas que combinan elementos públicos, privados y corporativos. Este artículo presenta un estado de la cuestión sobre las nuevas perspectivas teóricas y metodológicas para el análisis de estos procesos de hibridación, tomando como referencia el caso costarricense. A través de una revisión crítica de la literatura especializada, se identifican tres ejes fundamentales de investigación: la teoría de la gobernanza híbrida, el neoinstitucionalismo de elección racional y la teoría de la agencia en sistemas sanitarios complejos. El análisis revela que las transformaciones no constituyen procesos de privatización radical, sino reconfiguraciones graduales que preservan formalmente principios universalistas mientras introducen mecanismos de mercado y gestión empresarial. Se argumenta que estas dinámicas requieren marcos analíticos específicos que trasciendan dicotomías simplistas entre Estado y mercado, reconociendo la emergencia de formas complejas de coordinación multiactoral. Las perspectivas identificadas ofrecen herramientas conceptuales para comprender cómo las reformas institucionales afectan la equidad en el acceso a servicios preventivos esenciales, con implicaciones para el diseño de políticas públicas más efectivas y equitativas.
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Referencias
Acuña Ulate, Ana y Elena Fuentes Bolaños. Costa Rica: La reforma del sector salud y su impacto en la seguridad social. Washington: OPS, 2003.
Almeida, Celia. “Políticas sociales en América Latina: el giro neoliberal.” Revista CEPAL 76 (2002): 123-140.
Angrist, Joshua D. y Jörn-Steffen Pischke. Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton: Princeton University Press, 2008.
Arrow, Kenneth J. “Uncertainty and the welfare economics of medical care.” American Economic Review 53, no. 5 (1963): 941-973.
Arthur, W. Brian. “Competing technologies, increasing returns, and lock-in by historical events.” Economic Journal 99, no. 394 (1989): 116-131.
Banco Mundial. World Development Report 1993: Investing in Health. Washington: World Bank, 1993.
Banco Mundial. World Development Report 1997: The State in a Changing World. Washington: World Bank, 1997.
Báscolo, Ernesto, Natalia Houghton y Amalia Del Riego. “Lógicas de transformación de los sistemas de salud en América Latina y resultados en acceso y cobertura de salud.” Revista Panamericana de Salud Pública 42 (2018). https://doi.org/10.26633/rpsp.2018.126
Beach, Derek y Rasmus Brun Pedersen. Process-Tracing Methods: Foundations and Guidelines. Ann Arbor: University of Michigan Press, 2013.
Bennett, Andrew y Jeffrey T. Checkel, eds. Process Tracing: From Metaphor to Analytic Tool. Cambridge: Cambridge University Press, 2015.
Bernheim, B. Douglas y Michael D. Whinston. “Common agency.” Econometrica 54, no. 4 (1986): 923-942.
Besharov, Marya L. y Wendy K. Smith. “Multiple institutional logics in organizations.” Academy of Management Review 39, no. 3 (2014): 364-381.
Bevan, Gwyn y Christopher Hood. “What’s measured is what matters: Targets and gaming in the English public health care system.” Public Administration 84, no. 3 (2006): 517-538.
Blomqvist, Åke. “The doctor as double agent: Information asymmetry, health insurance, and medical care.” Journal of Health Economics 10, no. 4 (1991): 411-432.
Borgatti, Stephen P., Ajay Mehra, Daniel J. Brass y Giuseppe Labianca. “Network analysis in the social sciences.” Science 323, no. 5916 (2009): 892-895.
Bossert, Thomas y Tobias Leisewitz. “Innovation and Change in the Chilean Health System.” New England Journal of Medicine 374, no. 1 (2016): 1-5. https://doi.org/10.1056/NEJMp1514202
Bovens, Mark. “Analysing and Assessing Accountability: A Conceptual Framework.” European Law Journal 13, no. 4 (2007): 447-468.
Bradach, Jeffrey L. y Robert G. Eccles. “Price, authority, and trust: From ideal types to plural forms.” Annual Review of Sociology 15 (1989): 97-118.
Bravo-Cedeño, Edwin A. y Henry J. Vegas-Meléndez. “Modelo de la Nueva Gestión Pública en la Administración de Hospitales.” Digital Publisher CEIT 8, no. 6 (2023): 317-332.
Capoccia, Giovanni y R. Daniel Kelemen. “The study of critical junctures: Theory, narrative, and counterfactuals.” World Politics 59, no. 3 (2007): 341-369.
Caja Costarricense de Seguro Social. Informe de Auditoría Interna AS-ASALUD-0141-2024. San José: CCSS, 2024.
Caja Costarricense de Seguro Social. Informe de gestión anual 2023. San José: CCSS, 2024.
Caja Costarricense de Seguro Social. “CCSS readjudicó construcción del nuevo hospital de Cartago.” Nota de prensa, 18 de marzo, 2025.
CEPAL. “El sector privado en el sistema de salud de Costa Rica.” Serie Financiamiento del Desarrollo, N.º 109, 2001.
Chamizo García, Horacio Alejandro. “Las relaciones de agencia en el primer nivel de atención en salud.” Horizonte Sanitario 10, no. 2 (2011): 7-21. https://doi.org/10.19136/hs.a10n2.120
Christensen, Tom y Per Lægreid. “The Whole-of-Government Approach to Public Sector Reform.” Public Administration Review 67, no. 6 (2007): 1059-1066.
Clark, Mary A. “Health sector reform in Costa Rica: Reinforcing a public system.” Ponencia preparada para los Woodrow Wilson Center Workshops on the Politics of Education and Health Reforms, Washington, D.C., 18-19 de abril de 2002.
Collier, David y Steven Levitsky. “Democracy with Adjectives: Conceptual Innovation in Comparative Research.” World Politics 49, no. 3 (1997): 430-451.
Cornwall, Andrea y Karen Brock. “What do buzzwords do for development policy? A critical look at ‘participation’, ‘empowerment’ and ‘poverty reduction’.” Third World Quarterly 26, no. 7 (2005): 1043-1060.
Crenshaw, Kimberlé. “Mapping the margins: Intersectionality, identity politics, and violence against women of color.” Stanford Law Review 43, no. 6 (1991): 1241-1299.
Creswell, John W. y Vicki L. Plano Clark. Designing and Conducting Mixed Methods Research. Thousand Oaks: Sage Publications, 2017.
Denis, Jean-Louis, Ewan Ferlie y Nicolette Van Gestel. “Understanding hybridity in public organizations.” Public Administration 93, no. 2 (2015): 273-289.
Denzin, Norman K. The Research Act: A Theoretical Introduction to Sociological Methods. Nueva York: McGraw-Hill, 1978.
DiMaggio, Paul J. y Walter W. Powell. “The iron cage revisited: Institutional isomorphism and collective rationality.” American Sociological Review 48, no. 2 (1983): 147-160.
Donabedian, Avedis. “Evaluating the quality of medical care.” The Milbank Memorial Fund Quarterly 44, no. 3 (1966): 166-206.
Doyal, Lesley. What Makes Women Sick: Gender and the Political Economy of Health. Londres: Macmillan, 1995.
Elder, Glen H., Monica Kirkpatrick Johnson y Robert Crosnoe. “The emergence and development of life course theory.” En Handbook of the Life Course, editado por Jeylan T. Mortimer y Michael J. Shanahan, 3-19. Nueva York: Springer, 2003.
Epstein, Joshua M. Generative Social Science: Studies in Agent-Based Computational Modeling. Princeton: Princeton University Press, 2006.
Esping-Andersen, Gøsta. The Three Worlds of Welfare Capitalism. Princeton: Princeton University Press, 1990.
Esteban, Mari Luz. Antropología del cuerpo: Género, itinerarios corporales, identidad y cambio. Barcelona: Edicions Bellaterra, 2004.
Evans, Peter. Embedded Autonomy: States and Industrial Transformation. Princeton: Princeton University Press, 1995.
Evans, Robert G. “Going for the gold: The redistributive agenda behind market-based health care reform.” Journal of Health Politics, Policy and Law 22, no. 2 (1997): 427-465.
Ferlie, Ewan, Lynn Ashburner, Louise Fitzgerald y Andrew Pettigrew. The New Public Management in Action. Oxford: Oxford University Press, 1996.
Ferrinho, Paulo, Wim Van Lerberghe, Inês Fronteira, Fátima Hipólito y André Biscaia. “Dual practice in the health sector: Review of the evidence.” Human Resources for Health 2, no. 1 (2004): 14. https://doi.org/10.1186/1478-4491-2-14
Field, Mark G. “The health system and the polity: A contemporary American perspective.” Social Science & Medicine 7, no. 10 (1973): 709-717.
Fung, Archon, Mary Graham y David Weil. Full Disclosure: The Perils and Promise of Transparency. Cambridge: Cambridge University Press, 2007.
García-Prado, Ariadna y Paula González. “Whom Do Physicians Work For? An Analysis of Dual Practice in the Health Sector.” Journal of Health Politics, Policy and Law 36, no. 2 (2011): 265-294. https://doi.org/10.1215/03616878-1222721
Gertler, Paul J, Sebastian Martinez, Patrick Premand, Laura B. Rawlings, Christel M. J. Vermeersch. Impact Evaluation in Practice. Washington: World Bank, 2016.
Giddens, Anthony. The Constitution of Society: Outline of the Theory of Structuration. Berkeley: University of California Press, 1984.
Gilbert, Nigel y Klaus G. Troitzsch. Simulation for the Social Scientist. Buckingham: Open University Press, 2005.
González-Block, Miguel Ángel, Hortensia Reyes Morales, Lucero Cahuana Hurtado, Alejandra Balandrán y Edna Méndez. "Mexico: Health System Review." Health Systems in Transition 22, no. 2 (2020): 1-222.
Hedström, Peter y Richard Swedberg, eds. Social Mechanisms: An Analytical Approach to Social Theory. Cambridge: Cambridge University Press, 1998.
Helderman, Jan-Kees. “Bringing the market back in? Institutional complementarity and hierarchy in Dutch housing and health care.” Journal of Public Policy 27, no. 1 (2007): 113-139.
Hervey, Tamara K. y Jean V. McHale, eds. Health Systems Governance in Europe: The Role of EU Law and Policy. Cambridge: Cambridge University Press / European Observatory on Health Systems and Policies, 2010.
Homedes, Nuria y Antonio Ugalde. “Why neoliberal health reforms have failed in Latin America.” Health Policy 71, no. 1 (2005): 83-96.
Homedes, Nuria y Antonio Ugalde. “La privatización de los servicios de salud en América Latina.” Salud Pública de México 44, no. 3 (2002): 231-240.
Hood, Christopher. “A public management for all seasons?” Public Administration 69, no. 1 (1991): 3-19.
Hooghe, Liesbet y Gary Marks. “Unraveling the central state, but how? Types of multi-level governance.” American Political Science Review 97, no. 2 (2003): 233-243.
Horn, Murray J. The Political Economy of Public Administration. Cambridge: Cambridge University Press, 1995.
Hunter, David J. “The new public management in Britain: Implications for health care management.” Health Services Management Research 9, no. 3 (1996): 166-175.
Israel, Barbara A, Amy J. Schulz, Edith A. Parker y Adam B. Becker. “Review of community-based research: Assessing partnership approaches to improve public health.” Annual Review of Public Health 19, no. 1 (1998): 173-202.
Jensen, Michael C. y William H. Meckling. “Theory of the firm: Managerial behavior, agency costs and ownership structure.” Journal of Financial Economics 3, no. 4 (1976): 305-360.
Jessop, Bob. “From governance to governance failure and from multi-level governance to multi-scalar meta-governance.” En The Ashgate Research Companion to Planning Theory, 201-214. Londres: Ashgate, 2009.
Jessop, Bob. “Meta-governance and the state: Strategies, dilemmas and democratic responses.” Policy & Politics 39, no. 2 (2011): 185-204.
Kabeer, Naila. “Resources, agency, achievements: Reflections on the measurement of women’s empowerment.” Development and Change 30, no. 3 (1999): 435-464.
Kaufmann, Daniel, Aart Kraay y Massimo Mastruzzi. “Governance Matters VIII: Aggregate and Individual Governance Indicators.” World Bank Policy Research Working Paper 4978, 2009.
Kickbusch, Ilona y Dorothea Gleicher. Governance for Health in the 21st Century. Ginebra: WHO, 2012.
Laffont, Jean-Jacques y Jean Tirole. A Theory of Incentives in Procurement and Regulation. Cambridge: MIT Press, 1993.
Lazer, David, Alex Pentland, Lada Adamic, Sinan Aral, Albert-László Barabási, Devon Brewer, Nicholas Christakis, Noshir Contractor, James Fowler, Myron Gutmann, Tony Jebara, Gary King, Michael Macy, Deb Roy y Marshall Van Alstyne “Computational social science.” Science 323, no. 5915 (2009): 721-723.
Le Grand, Julian. Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens. Oxford: Oxford University Press, 2003.
Le Grand, Julian, Nicholas Mays y Jo-Ann Mulligan, eds. Learning from the NHS Internal Market. Londres: King’s Fund, 1998.
Lehmbruch, Gerhard. “Concertation and the structure of corporatist networks.” En Order and Conflict in Contemporary Capitalism, editado por John H. Goldthorpe, 60-80. Oxford: Oxford University Press, 1984.
Levesque, Jean-Frederic, Mark F. Harris y Grant Russell. “Patient-centred access to health care: Conceptualising access at the interface of health systems and populations.” International Journal for Equity in Health 12, no. 1 (2013): 18.
Lewis, Jenny M., Mark Considine y Damon Alexander. Networks, Innovation and Public Policy: Politicians, Bureaucrats and the Pathways to Change inside Government. Londres: Palgrave Macmillan, 2008.
Lindblom, Charles E. “The science of ‘muddling through’.” Public Administration Review 19, no. 2 (1959): 79-88.
Lipsky, Michael. Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. Nueva York: Russell Sage Foundation, 1980.
Londoño, Juan Luis y Julio Frenk. “Structured pluralism: Towards an innovative model for health system reform in Latin America.” Health Policy 41, no. 1 (1997): 1-36.
Lynch, Julia. Age in the Welfare State: The Origins of Social Spending on Pensioners, Workers, and Children. Cambridge: Cambridge University Press, 2006.
Maceira, Daniel. “Fragmentación e Incentivos en los Sistemas de Atención de la Salud en América Latina y el Caribe.” Nota Técnica IDB-TN-274. Washington: Banco Interamericano de Desarrollo, 2011. https://doi.org/10.18235/0012021
Macneil, Ian R. “Contracts: Adjustment of long-term economic relations under classical, neoclassical, and relational contract law.” Northwestern University Law Review 72, no. 6 (1978): 854-905.
Mahoney, James. “Strategies of causal inference in small-N analysis.” Sociological Methods & Research 28, no. 4 (2000): 387-424.
Mahoney, James y Kathleen Thelen. Explaining Institutional Change: Ambiguity, Agency, and Power. Cambridge: Cambridge University Press, 2010.
March, James G. y Johan P. Olsen. “The Logic of Appropriateness.” Arena Working Papers WP 04/09, 2004.
Martínez Franzoni, Juliana y Diego Sánchez-Ancochea. “La pandemia de enfermedad por coronavirus (COVID-19) y las narrativas de la política social en Costa Rica.” Revista de la CEPAL 139 (2023): 101-112.
Martínez Franzoni, Juliana y Diego Sánchez-Ancochea. The Quest for Universal Social Policy in the South: Actors, Ideas and Architectures. Cambridge: Cambridge University Press, 2020.
Martínez Franzoni, Juliana. “Welfare regimes in Latin America: Capturing constellations of markets, families, and policies.” Latin American Politics and Society 50, no. 2 (2008): 67-100.
McPake, Barbara, Giuliano Russo, David Hipgrave, Krishna Hort y James Campbell. “Implications of dual practice for universal health coverage.” Bulletin of the World Health Organization 94, no. 2 (2016): 142-146. https://doi.org/10.2471/BLT.14.151894
Mesa-Lago, Carmelo. Las reformas de salud en América Latina y el Caribe: su impacto en los principios de la seguridad social. Santiago: CEPAL, Serie Políticas Sociales N.º 120, 2006.
Milgrom, Paul y John Roberts. “An economic approach to influence activities in organizations.” American Journal of Sociology 94, Supplement (1988): S154-S179.
Ministerio de Salud de Costa Rica. Cuentas de Salud de Costa Rica 2020-2021. San José: Ministerio de Salud, 2022.
Ministerio de Salud de Costa Rica. “Oficialización de la Norma Nacional para la Atención Integral del Cáncer de Mama en Costa Rica.” La Gaceta. 2024.
Ministerio de Salud de Costa Rica. Informe sobre gobernanza y rectoría sanitaria. San José: Ministerio de Salud, 2023.
Miranda, Guido. La seguridad social y el desarrollo en Costa Rica. San José: EDNASSS, 1994.
Mossialos, Elias, Anna Dixon, Josep Figueras y Joe Kutzin, eds. Funding Health Care: Options for Europe. Buckingham: Open University Press / European Observatory on Health Systems and Policies, 2002.
North, Douglass. Institutions, Institutional Change and Economic Performance. Cambridge: Cambridge University Press, 1990.
Nussbaum, Martha C. Creating Capabilities: The Human Development Approach. Cambridge: Harvard University Press, 2011.
Nutbeam, Don. “Health literacy as a public health goal: A challenge for contemporary health education and communication strategies.” Health Promotion International 15, no. 3 (2000): 259-267.
Organización Internacional del Trabajo. Informe sobre empleo público en América Latina. Ginebra: OIT, 2022.
Organización Panamericana de la Salud. Indicadores básicos de salud en Costa Rica. Situación de salud en las Américas. Washington, D.C.: OPS, 2023.
Organización Panamericana de la Salud. Perfil del sistema de servicios de salud: Costa Rica. San José: OPS, 2019.
Organización Panamericana de la Salud. Redes integradas de servicios de salud. Washington: OPS, 2010.
Ostrom, Elinor. Governing the Commons. Cambridge: Cambridge University Press, 1990.
O’Toole Jr., Laurence J. “Research on policy implementation: Assessment and prospects.” Journal of Public Administration Research and Theory 10, no. 2 (2000): 263-288.
Pache, Anne-Claire y Filipe Santos. “Inside the hybrid organization: Selective coupling as a response to competing institutional logics.” Academy of Management Journal 56, no. 4 (2013): 972-1001.
Pereira, Ann. “Evaluación de la gestión para la implementación de la alianza público-privada para el desarrollo Alsalus en el Área de Salud de Siquirres.” Trabajo Final de Graduación, Universidad de Costa Rica, 2021.
Pesec, Megan, Ashley VanderZanden y Hannah Ratcliffe. Comprehensive Primary Health Care Reform in Costa Rica. Boston: Ariadne Labs, 2020.
Piattoni, Simona. The Theory of Multi-Level Governance: Conceptual, Empirical, and Normative Challenges. Oxford: Oxford University Press, 2010.
Pierson, Paul. “Increasing Returns, Path Dependence, and the Study of Politics.” American Political Science Review 94, no. 2 (2000): 251-267.
Pierson, Paul. Politics in Time: History, Institutions, and Social Analysis. Princeton: Princeton University Press, 2004.
Pollitt, Christopher y Geert Bouckaert. Public Management Reform: A Comparative Analysis. Oxford: Oxford University Press, 2017.
Prats i Català, Joan. De la burocracia al management, del management a la gobernanza. Las transformaciones de las administraciones públicas de nuestro tiempo. Madrid: Instituto Nacional de Administración Pública, 2005.
Preker, Alexander S. y April Harding. Innovations in Health Service Delivery: The Corporatization of Public Hospitals. Washington: World Bank Publications, 2003.
Pressman, Jeffrey L. y Aaron B. Wildavsky. Implementation: How Great Expectations in Washington Are Dashed in Oakland. Berkeley: University of California Press, 1973.
Ragin, Charles C. The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies. Berkeley: University of California Press, 1987.
Ragin, Charles C. Fuzzy-Set Social Science. Chicago: University of Chicago Press, 2000.
Reason, Peter y Hilary Bradbury, eds. Handbook of Action Research: Participative Inquiry and Practice. Londres: Sage, 2001.
Repretel. “CCSS elimina contratos de 138 EBAIS.” 28 de marzo, 2025.
Revista Summa. “Costa Rica: Sector privado de salud busca desarrollar modelo de colaboración.” 17 de octubre, 2023.
Rihoux, Benoît y Charles C. Ragin, eds. Configurational Comparative Methods: Qualitative Comparative Analysis (QCA) and Related Techniques. Thousand Oaks: Sage, 2009.
Rodríguez Herrera, Adolfo. La reforma del sector salud en Costa Rica: evolución, situación actual y perspectivas. San José: Ministerio de Salud / OPS, 2005.
Rodríguez Herrera, Roberto. “Tercialización y corporativización en el sistema de salud costarricense.” Revista Costarricense de Salud Pública 15, no. 3 (2006): 45-60.
Rosero-Bixby, Luis. “La trayectoria del seguro social en Costa Rica.” En Reformas de salud en América Latina, editado por Carmelo Mesa-Lago, 75-122. Santiago: CEPAL, 2004.
Ross, Stephen A. “The economic theory of agency: The principal’s problem.” American Economic Review 63, no. 2 (1973): 134-139.
Rothgang, Heinz, Mirella Cacace, Lorraine Frisina, Simone Grimmeisen, Achim Schmid y Claus Wendt. The State and Healthcare: Comparing OECD Countries. Basingstoke: Palgrave Macmillan, 2010.
Sáenz, María del Rocío, José Luis Bermúdez y Mónica Acosta. “Sistemas de salud de Centroamérica y República Dominicana: desafíos para la universalidad, la equidad y la sostenibilidad.” Salud Pública de México 53, supl. 2 (2011).
Sáenz, Rodrigo, José Luis Bermúdez y Melvin Acosta. Sistemas de salud en Centroamérica y República Dominicana: desafíos para la universalidad, la equidad y la sostenibilidad. Washington: OPS, 2011.
Salamon, Lester M. The Tools of Government: A Guide to the New Governance. Oxford: Oxford University Press, 2002.
Salathé, Marcel, Linus Bengtsson,Todd J. Bodnar,Devon D. Brewer,John S. Brownstein,Caroline Buckee,Ellsworth M. Campbell,Ciro Cattuto,Shashank Khandelwal,Patricia L. Mabry,Alessandro Vespignani. “Digital epidemiology.” PLOS Computational Biology 8, no. 7 (2012). https://doi.org/10.1371/journal.pcbi.1002616
Saltman, Richard B. y Josep Figueras. “Analyzing the Evidence on European Health Care Reforms.” Health Affairs 17, no. 2 (1998): 85-108.
Sanderson, Ian. “Evaluation, policy learning and evidence-based policy making.” Public Administration 80, no. 1 (2002): 1-22.
Schedler, Andreas, Larry Diamond y Marc F. Plattner, eds. The Self-Restraining State: Power and Accountability in New Democracies. Boulder: Lynne Rienner Publishers, 1999.
Schmitter, Philippe C. “Still the Century of Corporatism?” The Review of Politics 36, no. 1 (1974): 85-131.
Scott, William R. Institutions and Organizations. Thousand Oaks: Sage Publications, 2000.
Semanario Universidad. “La historia del veto a los copagos.” 17 de enero, 2024.
Semanario Universidad. “CCSS tiene escasez de 700 médicos especialistas.” 15 de enero, 2025.
Sen, Amartya. “¿Por qué la equidad en salud?” Revista Panamericana de Salud Pública 11, no. 5/6 (2002): 302-309.
Sen, Gita, Piroska Östlin y Asha George. Unequal, Unfair, Ineffective and Inefficient: Gender Inequity in Health. Ginebra: WHO, 2007.
Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Nueva York: Doubleday, 1990.
Shadish, William R., Thomas D. Cook y Donald T. Campbell. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston: Houghton Mifflin, 2002.
Shim, Janet K. “Cultural health capital: A theoretical approach to understanding health care interactions and the dynamics of unequal treatment.” Journal of Health and Social Behavior 51, no. 1 (2010): 1-15.
Shortell, Stephen M, J L O'Brien, J M Carman, R W Foster, E F Hughes, H Boerstler, E J O'Connor. “Assessing the impact of continuous quality improvement/total quality management: Concept versus implementation.” Health Services Research 30, no. 2 (1995): 377-401.
Siddiqi, Sameen, Tayyeb I Masud, Sania Nishtar, David H Peters, Belgacem Sabri, Khalif M Bile y Mohamed A Jama “Framework for assessing governance of the health system in developing countries.” Health Policy 90, no. 1 (2009): 13-25.
Simon, Herbert A. “A behavioral model of rational choice.” Quarterly Journal of Economics 69, no. 1 (1955): 99-118.
Skelcher, Chris. “Jurisdictional Integrity, Polycentrism, and the Design of Democratic Governance.” Governance 18, no. 1 (2005): 89-110.
Sojo, Carlos. “Reformas al sistema de salud en Costa Rica: Tensiones y desafíos.” Revista de Ciencias Sociales 89-90 (2000): 33-46.
Solar, Orielle y Alec Irwin. A Conceptual Framework for Action on the Social Determinants of Health. Ginebra: WHO, 2007.
Streeck, Wolfgang y Kathleen Thelen, eds. Beyond Continuity: Institutional Change in Advanced Political Economies. Oxford: Oxford University Press, 2005.
Superintendencia General de Seguros. Informe anual del mercado de seguros 2023. San José: SUGESE, 2024.
Tashakkori, Abbas y Charles Teddlie. Handbook of Mixed Methods in Social and Behavioral Research. Thousand Oaks: Sage, 2003.
Teletica. “Más de un millón de ticos tienen seguro o plan prepago de salud privado.” 9 de septiembre, 2024.
Thelen, Kathleen. “How institutions evolve: Insights from comparative historical analysis.” En Comparative Historical Analysis in the Social Sciences, editado por James Mahoney y Dietrich Rueschemeyer, 208-240. Cambridge: Cambridge University Press, 2003.
Unger, Jean-Pierre, Pierre De Paepe, Renzo Buitrón y Werner Soors. “Promoting Universal Financial Protection: A Policy Analysis of Universal Health Coverage in Costa Rica (1940-2000).” Health Research Policy and Systems 11, no. 28 (2013). https://doi.org/10.1186/1478-4505-11-28
Van de Ven, Andrew H., Martin Ganco y C. R. Hinings. “Returning to the frontier of contingency theory of organizational and institutional designs.” Academy of Management Annals 7, no. 1 (2013): 393-440.
Van der Heijden, Jeroen. “Institutional layering: A review of the use of the concept.” Politics 31, no. 1 (2011): 9-18.
Vargas-Fuentes, Margarita. “Privatización de servicios públicos: El caso de los servicios de salud en Costa Rica.” Salud Pública de México 35, no. 2 (1993): 186-193.
Wasserman, Stanley y Katherine Faust. Social Network Analysis: Methods and Applications. Cambridge: Cambridge University Press, 1994.
Weiss, Linda. “The myth of the powerless state.” New Left Review 225 (1997): 3-27.
Wendt, Claus, Lorraine Frisina y Heinz Rothgang. “Healthcare system types: a conceptual framework for comparison.” Social Policy & Administration 43, no. 1 (2009): 70-90.
Weyland, Kurt. Bounded Rationality and Policy Diffusion: Social Sector Reform in Latin America. Princeton: Princeton University Press, 2006.
Whitehead, Margaret. “The concepts and principles of equity and health.” International Journal of Health Services 22, no. 3 (1992): 429-445.
Williamson, Oliver E. The Economic Institutions of Capitalism. Nueva York: Free Press, 1985.
Williamson, Oliver E. “Transaction-cost economics: The governance of contractual relations.” Journal of Law and Economics 22, no. 2 (1979): 233-261.
Wing, Coady, Kosali Simon y Ricardo A. Bello-Gomez. “Designing difference in difference studies: Best practices for public health policy research.” Annual Review of Public Health 39 (2018): 453-469.
Yashar, Deborah J. Demanding Democracy: Reform and Reaction in Costa Rica and Guatemala, 1870s-1950s. Stanford: Stanford University Press, 1997.
Yin, Robert K. Case Study Research: Design and Methods. Thousand Oaks: Sage, 2018.
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