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Int J Integr Care. 2009 Oct-Dec; 9(Suppl): e125.
Published online 31 December 2009.
PMCID: PMC2807065
Annual Conference Supplement 2009

Institutional integration, health and social care policy and social welfare: an application of the ‘path dependence’ theory in France



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.


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.


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.


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

Contributor Information

Hélène Trouvé, National Foundation of Gerontology, University of Paris Pantheon Sorbonne, Paris, France.

Dominique Somme, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France.

Yves Couturier, Research center on aging, University of Sherbrooke, Sherbrooke, Québec, Canada.

Francis Etheridge, Research center on aging, University of Sherbrooke, Sherbrooke, Québec, Canada.

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