Institutional integration, health and social care policy and social welfare: an application of the ‘path dependence’ theory in France
International Journal of Integrated Care, 31 December 2009 - ISSN 1568-4156
Poster abstract
Institutional integration, health and social care policy and social welfare: an application of the ‘path dependence’ theory in France
Hélène Trouvé, PhD, National Foundation of Gerontology, University of Paris Pantheon Sorbonne, Paris, France
Dominique Somme, MD, PhD, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
Yves Couturier, PhD, Research center on aging, University of Sherbrooke, Sherbrooke, Québec, Canada
Francis Etheridge, PhD(c), Research center on aging, University of Sherbrooke, Sherbrooke, Québec, Canada
Correspondence to: Hélène Trouvé, E-mail: helene.trouve@egp.aphp.fr
Abstract


Introduction: The PRISMA integration model is a promising method to implement integration in health and social services for elderly people. The PRISMA France study aims to investigate the implementation of this model, which relies on the establishment of advisory boards at institutional, organisational and professional levels of decision-making, in France. These boards are guided by whole systems thinking and function in a joined-up, co-ordinated manner.


Method: A qualitative approach was adopted to study the model's implementation. Analyses were based on semi-structured interviews with actors of all levels of decision-making, observations of advisory board meetings and administrative documentations. Validity was insured by triangulation methods and content saturation.


Results: Our analyses revealed the complexity, instability and fragmentation of the institutional governance of publics policies for elderly people. The ‘path dependence’ to the Bismarckian system and the incomplete reforms of gerontological policies generate a cohabitation of three concurrent policies (national, regional and local) and a juxtaposition of two institutional systems (health and social care policy and social welfare). In such a context, no institution possesses sufficient authority to determine gerontological policy.


Conclusion: In the light of these analyse, the particularly complex and time-consuming implementation of the PRISMA model in France can be better understood.

Keywords
path dependency; public policies; integrated health care networks; France

Poster presentation