Acknowledging the Emergence of a New Logic: The Regulation of Healthcare in Brazil

• Published date: 01 January 2024
• DOI: http://doi.org/10.1177/00953997231202237
• Author: Arnaldo Ryngelblum,José Estevam Freitas,Mayla Cristina Costa Maroni Saraiva
• Date: 01 January 2024
• Subject Matter: Articles

https://doi.org/10.1177/00953997231202237

Administration & Society

2024, Vol. 56(1) 50 –72

© The Author(s) 2023

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DOI: 10.1177/00953997231202237

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Article

Acknowledging the

Emergence of a New

Logic: The Regulation

of Healthcare in Brazil

Arnaldo Ryngelblum1, José Estevam Freitas1,

and Mayla Cristina Costa Maroni Saraiva2

Abstract

Studies of institutional change have focused on several themes. Yet,

examinations of small innovations still require attention. This question

is important because a new logic is usually only recognized after several

modifications have taken place; thus, noticing it early becomes relevant.

The emergence of a new logic presupposes new prescriptions about what is

appropriate for both businesses and society. This article examines Brazilian

health regulations that have undergone several alterations and suggests that

this occurrence can be identified only when actors begin to react to the

impact of such an event by changing their daily practices.

Keywords

change, institutional logics, regulation, healthcare

1Universidade Paulista, São Paulo, Brazil

2Universidade de Brasília, Brazil

Corresponding Author:

Mayla Cristina Costa Maroni Saraiva, Programa de Mestrado e Doutorado em Administração,

Universidade de Brasília, Campus Darcy Ribeiro, Prédio da FACE, Distrito Federal, Brasilia,

70910-900, Brazil.

Email: mayla.c.costa@gmail.com

1202237AAS0010.1177/00953997231202237Administration & SocietyRyngelblum et al.

research-article2023

Ryngelblum et al. 51

Introduction

In institutional studies, acknowledgment of change has mainly been exam-

ined as a finished process, suggesting that change events are sporadic. Over

the past 20 years, researchers in sociology, political science, and other fields

have studied how changes occur using different epistemologies and

approaches (Haveman & Gualtieri, 2017; Mahoney & Thelen, 2010; Mutch,

2018; Thornton et al., 2012) and have discussed different drivers, mecha-

nisms, and objects. In relation to the temporality of change, different issues

have been analyzed, such as pace and phases. However, whether a new logic

can only be perceived as a finished process or whether its construction can be

anticipated remains to be examined.

Friedland and Alford (1991) conceive of “institutions as patterns of activ-

ity” (p. 232) that provide a repertoire of possibilities by which organizations

and individuals behave. They also recognize the contradictory character of

relations between central institutions, with multiple logics available to vari-

ous actors. They consider that institutional transformations result from actors

taking advantage of the contradictions between these multiple logics to create

new social relationships and symbolic orders.

The institutional logics approach helps to explain institutional change

better than prior studies of organizational institutionalism (Greenwood

et al., 2011; Micelotta et al., 2017; Waldorff et al., 2013). Yet, the under-

standing of this approach is that first-order institutions remain practically

unchanged for long periods, while other elements such as identities, roles,

practices, resources, and rules can change; alternatively, according to

Thornton et al. (2012), change occurs at the meso or micro level. For

example, religion is a first-order logic in Western society, and regardless

of what denomination is analyzed, religious practices and values have

changed over the years and throughout the centuries. More recently, the

modified practices of various Christian churches are still recognized as

prior Catholic practices. Mutch (2018) uses examples of Lutheranism,

Calvinism, and Episcopalianism as modifications to previous Christian

practices and values.

Previous studies have tended to consider institutional change a transfor-

mational occurrence (Faik et al., 2020; Frenken et al., 2020; Greenwood

et al., 2011). This study’s focus is related to the frequency of innovations

introduced into a given context and how they constitute signs of future

change in prevailing institutional logic. To examine this issue, we use the

case of a regulatory change in the private health system in Brazil. We

review the literature on change, and the case we explore enhances under-

standing of how incremental changes contribute to a larger picture.