Abstract-This article uses political economy analysis to identify the factors that contributed to the adoption of policies to expand social protection in health (SPH) in Mexico in the early years of the 21st century. It focuses on the adoption stage of these policies to answer two questions: (1) Which contextual factors created the window of opportunity where SPH reforms could be adopted in Mexico? (2) What political strategies did the main actors driving the reform use to promote its adoption? Two types of analysis were developed: an analysis of the context and a stakeholder analysis. The analysis of the context was used to identify the "enabling factors" (epidemiological, political, and economic) that created the window of opportunity to place the problem of limited health care coverage in Mexico on the national policy agenda. The stakeholder analysis was used to (1) construct a map of actors, positions, and power during the deliberation of these policies in the Mexican Congress; (2) evaluate the behavior, intentions, interrelations, agendas, and interests of key actors; and (3) assess the influence and resources that actors brought to the debate and the strategies used by proponents to pursue and achieve adoption of the policies. This article shows that actors with high political power can take advantage of a propitious context (a window of opportunity for major change) through effective political strategies to design, promote, and successfully negotiate SPH policies, even in the absence of beneficiary mobilization. This was the case in the adoption of Mexico's health reform in 2003.
Keywords: political economy of universal health coverage; social protection in health; stakeholder analysis; universal health coverage.