Trend towards institutional stability: regulation, training, and provision of doctors in Brazil during the Lula government

Abstract

Abstract This article aims to analyse the characteristics of the regulation, training and supply policies of medical doctors in Brazil, during Lula government (2003-2010), as well as the process of dispute about a policy change proposed by senior officers of the Ministry of Health, who were members of the Health Reform movement. This is a case study that used process tracing as a methodological strategy and, as sources, documents and interviews. We used the theoretical resources offered by studies on political process and the theory of gradual institutional change. The main findings are the understanding of institutional arrangements in this policy, and the identification of individual and collective actors who acted to change the policy. Three political-institutional restrictions to change were found: the opposition of the Liberal Medicine advocates Community, which exerted a political influence on the area, the lack of support or resistance to change from the Ministry of Education and the government nucleus decision not to carry out proposals that, at the same time, had to be approved by the Legislative and had the opposition of the Liberal Medicine advocates Community. A balance tending to reproduce the status quo and the current institutional arrangement prevailed, despite the implementation of incremental policy changes.