Policies are made in response to the rationale of pressure and legitimization, which join forces in many different ways. This work analyzes the planning and adoption of the health reforms undertaken in Costa Rica between 1988 and 1998. It questions whether political parties, international financial institutions and the technical and bureaucratic elites in each sector can be taken as sufficiently explanatory of themselves. Empirical evidence would suggest that apart from investigating the individual interests of the agents involved, one must also consider the sector reforms that are actually available internationally. The paper draws this discussion into the larger scenario of policy making in Latin America and draws links between this and other stages in policy making and other moments in the construction of the State.