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The development of integration in the elderly care sector: a qualitative analysis of national policies and local initiatives in France and Sweden

Published online by Cambridge University Press:  26 December 2017

BLANCHE LE BIHAN  and
ALIS SOPADZHIYAN
BLANCHE LE BIHAN*
Affiliation:
French School of Public Health (EHESP), Rennes, France.
ALIS SOPADZHIYAN
Affiliation:
French School of Public Health (EHESP), Rennes, France.
*
Address for correspondence: Blanche Le Bihan, Department of Social Sciences, French School of Public Health (EHESP), Avenue du Professeur Léon Bernard, CS 74312–35043 Rennes Cedex, France E-mail: [email protected]
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Abstract

Due to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries – France and Sweden – where various policy measures aiming at developing and delivering integrated care can be identified: at the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double – local and national – approach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected.

Keywords

integration/co-ordinationpolicy processelderly careFranceSwedenterritoryMAIANorrtälje
Type
Article
Information
Ageing & Society , Volume 39 , Issue 5 , May 2019 , pp. 1022 - 1049
Copyright
Copyright © Cambridge University Press 2017 

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References

Ahgren, B. 2010. Competition and integration in Swedish health care. Health Policy, 96, 2, 91–7.Google Scholar
Ahgren, B. and Axelsson, R. 2011. A decade of integration and collaboration: the development of integrated health care in Sweden 2000–2010. International Journal of Integrated Care, 11, 5.Google Scholar
Amyot, J. J. 2006. Développer la coordination gérontologique. Stratégies, dispositifs et pratiques [Developing Gerontological Coordination. Strategies, Schemes and Practices]. Dunod, Paris.Google Scholar
Andersson, G. and Karlberg, I. 2000. Integrated care for the elderly. International Journal of Integrated Care, 1, e01.Google Scholar
Andersson Bäck, M. and Calltorp, J. 2013. The Norrtälje Model – a unique model for integrated health and social care in Sweden. The King's Fund, Forum for Health Policy, Göteborgs Universitet Report, Gothenburg, Sweden, 1–27.Google Scholar
Anttonen, A. 1990. The feminization of the Scandinavian welfare state. The welfare state in transition: from the social insurance state towards the social service state. In Simonen, L. (ed.), Finnish Debates on Women's Studies. Research Institute for Social Sciences, University of Tampere, Tampere, Finland, 3–49.Google Scholar
Argoud, D. 2014. Les politiques gérontologiques locales: la difficile constitution d'un espace autonome entre territorialisation et recentralisation [Local Gerontological Policies: The Difficult Establishment of an Autonomous Space Between Territorialisation and Recentralisation]. In Hummel, C., Mallon, I. and Caradec, V. (eds), Vieillesses et vieillissements. Regards sociologiques [Old Age and Ageing. Sociological Views]. Presses Universitaires de Rennes, Rennes, France, 49–60.Google Scholar
Axelsson, R. and Axelsson, B. S. 2006. Integration and collaboration in public health. A conceptual framework. International Journal of Health Planning and Management, 21, 1, 75–88.Google Scholar
Berglund, H., Blomberg, S., Dunér, A. and Kjellgren, K. 2015. Organizing integrated care for older persons: strategies in Sweden during the past decade. Journal of Health Organization and Management, 29, 1, 128–51.Google Scholar
Bloch, M. A. 2013. Les dispositifs d'aide et de prise en charge [Caring and supporting schemes]. Actualité et Dossier en Santé Publique (ADSP), 85, 30–5.Google Scholar
Bloch, M. A. and Hénaut, L. 2014. Coordination et parcours. La dynamique du monde sanitaire, social et médico-social [Coordination and Pathways. Dynamics of the Health, Social and Medico-social World]. Dunod, Paris.Google Scholar
Blomqvist, P. 2004. The choice revolution: privatization of Swedish welfare services in the 1990s. Social Policy & Administration, 38, 2, 139–55.Google Scholar
Callahan, C. 2010. Case management for Alzheimer's disease in primary care. In Actes Du Case Management Workshop, 8–9 Mars. Fondation de Coopération Scientifique pour la Recherche sur la Maladie D'Alzheimer et les maladies apparentées (FCS), Paris, 66–76.Google Scholar
Challis, D. and Davis, B. 1986. Case Management in Community Care. Gower, Aldershot, UK.Google Scholar
CNSA 2017. Evaluation des dispositifs MAIA et appui à la mise en œuvre des recommandations [Evaluation of the MAIA scheme and recommendations]. Final Evaluation Report, CNSA, Paris.Google Scholar
Erlandsson, S., Storm, P., Stranz, A., Szebehely, M. and Trydegård, G. B. 2013. Marketising trends in Swedish eldercare: competition, choice and calls for stricter regulation. In Meagher, G. and Szebehely, M. (eds), Marketisation in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences. Stockholm Studies in Social Work 30, Stockholm University, Stockholm, 23–83.Google Scholar
Eurostat 2016. Population (Demography, Migration and Projections), Population data. Available online at http://ec.europa.eu/eurostat/web/population-demography-migration-projections/population-data [Accessed 28 November 2016].Google Scholar
Frinault, T. 2009. La dépendance. Un nouveau défi pour l'action publique [Dependency. A New Challenge for Public Policy]. Presses Universitaires de Rennes, Rennes, France.Google Scholar
Frossard, M., Genin, M., Guisset, M. J. and Villez, A. 2004. Providing integrated health and social care for older persons in France – an old idea with a great future. In Leichsenring, K. and Alaszewski, A. M. (eds), Providing Integrated Health and Social Care for Older Persons. An Overview of Issues at Stake. European Centre Vienna, Ashgate, Vienna, 229–67.Google Scholar
Goodwin, N., Dixon, A., Anderson, G. and Wodchis, W. 2014. Providing Integrated Care for Older People with Complex Needs. Lessons from Seven International Case Studies. The King's Fund, London.Google Scholar
Ham, C. 2012. Competition and integration in health care reform. International Journal of Integrated Care, 12, 2.Google Scholar
Hardy, B., Mur-Veemanu, I., Steenbergen, M. and Wistow, G. 1999. Inter-agency services in England and The Netherlands. A comparative study of integrated care development and delivery. Health Policy, 48, 2, 87–105.Google Scholar
Hedman, N. O., Johansson, R. and Rosenqvist, U. 2007. Clustering and inertia: structural integration of home care in Swedish elderly care. International Journal of Integrated Care, 7, 3.Google Scholar
Henrard, J. C. 2002. Le système français d'aide et de soins aux personnes âgées [The French health and social care system for older people]. Santé, Société et Solidarité, 1, 2, 73–82.Google Scholar
Henrard, J. C. and Vedel, I. 2003. L'enjeu de la coordination gérontologique en France [The gerontological coordination challenge in France]. Santé, Société et Solidarité, 2, 2, 77–84.Google Scholar
Hieda, T. 2012. Political Institutions and Elderly Care Policy: Comparative Politics of Long-term Care in Advanced Democracies. Palgrave Macmillan, London.Google Scholar
Humphries, R. 2015. Integrated health and social care in England – progress and prospects. Health Policy, 119, 7, 856–9.Google Scholar
Kodner, D. 2006. Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessons. Health & Social Care in the Community, 14, 5, 384–90.Google Scholar
Kodner, D. 2009. All together now: a conceptual exploration of integrated care. Healthcare Quarterly, 13, special issue, 6–15.Google Scholar
Kodner, D. and Kyriacou, C. K. 2000. Fully integrated care for frail elderly: two American models. International Journal of Integrated Care, 1.Google Scholar
Kodner, D. and Spreeuwenberg, C. 2002. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care, 2, 4.Google Scholar
Kremer, M. 2006. Consumers in charge of care: the Dutch personal budget and its impact on the market, professionals and the family. European Societies, 8, 3, 385–401.Google Scholar
Le Bihan, B. and Martin, C. 2007. Cash for care in the French welfare state: a skilful compromise. In Ungerson, C. and Yeandle, S. (eds), Cash for Care in Developed Welfare States. Palgrave Macmillan, London, 39–52.Google Scholar
Le Bihan, B. and Martin, C. 2012. Diversification of care policy measures supporting older people: towards greater flexibility for carers? European Journal of Ageing, 9, 2, 141–50.Google Scholar
Leichsenring, K. 2004. Developing integrated health and social care services for older persons in Europe. International Journal of Integrated Care, 4, 3.Google Scholar
Leichsenring, K., Rodrigues, R., Winkelmann, J. and Falk, R. 2015. Integrated Care, Choice and Competition. Challenges and Strategies of Care Coordination in the Context of Market-oriented Governance in Germany and Sweden. European Centre for Social Welfare Policy and Research, Vienna.Google Scholar
Leutz, W. N. 1999. Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. The Milbank Quarterly, 77, 1, 77–110, iv–v.Google Scholar
Maroy, C. 1995. L'analyse qualitative d'entretiens [The qualitative analysis of interviews]. In Albarello, L., Digneffe, F., Hiernaux, J. P., Maroy, C. and de Saint-Georges, P. (eds), Pratiques et méthodes de recherche en sciences sociales [Practices and Methodology on Social Sciences]. Armand Colin, Paris, 83–110.Google Scholar
Meagher, G. and Szebehely, M. 2013. Long-term care in Sweden: trends, actors, and consequences. In Ranci, C. and Pavolini, E. (eds), Reforms in Long-term Care Policies in Europe. Springer-Verlag, New York, 55–78.Google Scholar
Meinow, B., Parker, M. G. and Thorslund, M. 2011. Consumers of eldercare in Sweden: the semblance of choice. Social Science & Medicine, 73, 9, 1285–9.Google Scholar
Mur-Veeman, I., van Raak, A. and Paulus, A. 2008. Comparing integrated care policy in Europe: does policy matter? Health Policy, 85, 2, 172–83.Google Scholar
Øvretveit, J. and Brommels, M. 2011. Review of Research into Comprehensive Integrated Care Systems. The Medical Management Centre, Karolinska Universitet, Stockholm.Google Scholar
Øvretveit, J., Hansson, J. and Brommels, M. 2010. An integrated health and social care organisation in Sweden: creation and structure of a unique local public health and social care system. Health Policy, 97, 2/3, 113–21.Google Scholar
Pavolini, E. and Ranci, C. 2013. Reforms to Long Term care: An introduction. In Constanzo, R. and Pavolini, E. (eds), Reforms in Long-Term Care Policies in Europe. Investigating Institutional Change and Social Impacts, Springer-Verlag, New York.Google Scholar
Pays de, Rennes, 2013. http://www.paysderennes.fr/-Profil-du-territoire-.htmlGoogle Scholar
Schön, P., Hagman, L. and Wanell, S. E. 2012. Kan Två Bli En? TioHundraprojektets Effecter På Vård Och Omsorg För Måmgruppen de Mest Sjuka äldre [Can Two Becone One? Implementing an Integrated Health and Social Care Organization for the Oldest Old with Complex Health Problems]. Stiftelsen Stockholms läns Äldrecentrum, Stockholm.Google Scholar
Sjögren, E. and Åhblom, P. 2012. The TioHundra Project: Tools for Realizing Integration. Leading Health Care (LHC), Stockholm, Chapter 8.Google Scholar
Socialstyrelsen 2013. Stimulansbidrag LOV. Delrapport 2013, Socialstyrelsen, Stockholm.Google Scholar
Somme, D. and de Stampa, M. 2011. Ten years of integrated care for the older in France. International Journal of Integrated Care, 11, 5, special 10th anniversary edition.Google Scholar
Somme, D., Trouvé, H., Passadori, Y., Corvez, A., Jeandel, C., Bloch, M. A., Ruault, G., Dupont, O. and de Stampa, M. 2014 a. The French Society of Geriatrics and Gerontology position paper on the concept of integration. International Journal of Integrated Care, 14, 1.Google Scholar
Somme, D., Trouvé, H., Perisset, C., Corvol, A., Ankri, J., Saint-Jean, O. and de Stampa, M. 2014 b. Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration. International Journal of Integrated Care, 14, 2.Google Scholar
Ström Falk, R. 2015. Competing logics? The coexistence of integrated care and customer choice in the organisation and provision of home-based care. Master's thesis Stockholm University, Stockholm.Google Scholar
Szebehely, M. and Trydegård, G. B. 2012. Home care for older people in Sweden: a universal model in transition. Health & Social Care in the Community, 20, 3, 300–9.Google Scholar
Thompson, G., Frances, J., Levacic, R. and Mitchell, J. 1991. Markets, Hierarchies and Networks. The Coordination of Social Life. Sage, London.Google Scholar
Trouvé, H., Couturier, Y., Etheridge, F., Saint-Jean, O. and Somme, D. 2010. The path dependency theory: analytical framework to study institutional integration. The case of France. International Journal of Integrated Care, 10, 2, 1–9.Google Scholar
Trydegård, G. B. 2003. Swedish care reforms in the 1990s. A first evaluation of their consequences for the elderly people. Revue française des affaires sociales, 4, 4, 443–60.Google Scholar
Trydegård, G. B. and Thorslund, M. 2010. One uniform welfare state or a multitude of welfare municipalities? The evolution of local variation in Swedish elder care. Social Policy & Administration, 44, 4, 495–511.Google Scholar
Valentijn, P. P., Schepman, S. M., Opheij, W. and Bruijnzeels, M. A. 2013. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13, 1.Google Scholar
Williams, P. M. 2002. The competent boundary spanner. Public Administration, 80, 1, 103–24.Google Scholar
Williams, P. and Sullivan, H. 2009. Faces of integration. International Journal of Integrated Care, 9, 4.Google Scholar