{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:30Z","timestamp":1790657910344,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sociol."],"abstract":"<jats:p>\n                    The public hospital in Latin America is currently undergoing a sociological metamorphosis driven by chronic systemic failure. This article posits that, contrary to its design, the hospital frequently functions as a total institution by default\u2014a space defined by surveillance, bureaucratic rationing, and the mortification of the self. Through a theoretical and conceptual synthesis grounded in a systematic documentary analysis of 31 primary units, this study contrasts the\n                    <jats:italic>external narrative<\/jats:italic>\n                    of performative governmental modernization with the internal reality of structural collapse. Integrating Goffman\u2019s analytical heuristic with the framework of street-level bureaucracy, we analyze the \u201cdouble erosion\u201d of quality of life affecting both the workforce\u2014manifesting in epidemic rates of burnout syndrome\u2014and the patient population, who suffer systematic dehumanization. The findings reveal that staff depersonalization is a survival mechanism necessitated by resource scarcity, inadvertently causing the objectification of the patient. While the persistence of this crisis is maintained by a structural opacity that obscures the true diagnosis of the sector, counterexamples of primary care resilience demonstrate this totalization is not deterministic. We conclude that de-totalization requires not only meeting a GDP investment target but also a fundamental restructuring of the power dynamics within the clinical encounter.\n                  <\/jats:p>","DOI":"10.3389\/fsoc.2026.1956466","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:33:33Z","timestamp":1790656413000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic failure and the totalization of public hospitals: a theoretical and conceptual synthesis of health governance in Latin America"],"prefix":"10.3389","volume":"11","author":[{"given":"Mauro Marino","family":"Jim\u00e9nez","sequence":"first","affiliation":[{"name":"Facultad de Comunicaci\u00f3n, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariella","family":"Montes-Vecco","sequence":"additional","affiliation":[{"name":"Facultad de Comunicaci\u00f3n, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Nu\u00f1ez-Zambrano","sequence":"additional","affiliation":[{"name":"Facultad de Comunicaci\u00f3n, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","volume-title":"Holocausto Brasileiro: Vida, Genoc\u00eddio e 60 Mil Mortes no Maior Hosp\u00edcio do BRASIL","author":"Arbex","year":"2013"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.1215\/9780822395287","volume-title":"Patients of the State: The Politics of Waiting in Argentina","author":"Auyero","year":"2012"},{"key":"ref3","volume-title":"ISGlobal en Am\u00e9rica Latina: Bas\u00e1ndonos en las Historias De \u00c9xito Para Expandir la Agenda en Salud Global y Abordar las Necesidades de Salud P\u00fablica. 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