Abstract
A multiple-case study was conducted to explain the relationship between the governance of the Buenos Aires Public Health Insurance (PHI) implementation process and its effectiveness in 8 municipalities. The heterogeneity in the effectiveness of PHI implementation was explained by the characteristics of the governance implementation process. The local health authorities' position on the PHI (favorable reception, formal acceptance, or rejection) influenced the nature of the articulation of the PHI within the municipal health system. Support for local management teams on the part of the municipal health and social development authorities affected the possibilities of implementing strategies to overcome unfavorable context-related conditions.