it “[…] patients at the center and the heart of the priorities of the entire system”: Critical Discourse Analysis in global/local documents on Primary Health Care in Chile

Abstract

The New Public Management (NPM) as a management strategy has influenced the design of the health system in Chile, so that both access and the right to health have historically been crossed by the formation of a subsidiary State, the emergence of market logic, and the acquisition of clients (patients). The present study was conducted under a methodology of global and local public policy analysis, supported by Critical Discourse Analysis, seeking to understand the effects of NPM on PHC in Chile. For this, two texts were selected: The Declaration of Astana (2018) and the Presidential Speech of Sebastián Piñera at the presentation of the Better Fonasa bill (2020). After the analysis of the toolboxes of Jäger (2003) and Rivera-Aguilera (2017), a growing managerial advance in Chilean PHC was perceived as a result, reflected in strategies such as the link between financing and the achievement of care goals, programs, and work based on per capita, which ends up representing a threat to access and universal right to health.