The barriers to govern long-term care innovations: the paradoxical role of subsidies in a transition program.

This study deals with the governance of a transition program (2007-2011) that tried to radically change a fragmented, supply-driven long-term care system into an integrated, demand-driven system to deal with an aging population. The transition program was subsidized by the healthcare ministry and enabled 26 projects throughout the Netherlands. The idea was to first experiment with innovative long-term care practices outside the system and then to scale-up these innovations to change the system. However, previous research does not highlight examples of long-term care innovations that scaled-up. Hence, the goal is to explore the barriers to govern the scaling-up of the long-term care innovations. The barriers were identified by participating in the program and interviewing ministry, program and project actors. The core barrier was the lack of commitment to the empowerment. It resulted from the subsidy focus of the projects and the lack of protection of the innovations, and from conflicts of interests and power struggles on the ministry-level. A transition program requires more than providing a subsidy. Policymakers have to learn from innovations outside the system in order to change it. Simultaneously, projects should not be entirely subsidized, otherwise there are no incentives to scale-up the innovations.

[1]  Adrian Smith,et al.  Designing long-term policy: rethinking transition management , 2009 .

[2]  H. Boeije.  A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews , 2002 .

[3]  K. Oliver,et al.  The human factor: re-organisations in public health policy. , 2012, Health policy.

[4]  Lars Coenen,et al.  Towards a spatial perspective on sustainability transitions , 2012 .

[5]  R. Raven.  Strategic niche management for biomass: a comparative study on the experimental introduction of bioenergy technologies in the Netherlands and Denmark , 2005 .

[6]  A. V. van Raak,et al.  Integrated care: the impact of governmental behaviour on collaborative networks. , 1999, Health policy.

[7]  J. Ovretveit,et al.  Linking research to practice: the organisation and implementation of The Netherlands health and social care improvement programmes. , 2013, Health policy.

[8]  J. Schot,et al.  Regime shifts to sustainability through processes of niche formation : the approach of strategic niche management , 1998 .

[9]  Demand-driven elderly care in the Netherlands , 2007 .

[10]  Anna De Fina,et al.  The ethnographic interview , 2019, The Routledge Handbook of Linguistic Ethnography.

[11]  P. Bower,et al.  An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator , 2012, BMC Health Services Research.

[12]  Frank W. Geels,et al.  Strategic niche management and sustainable innovation journeys: theory, findings, research agenda, and policy , 2008, Technol. Anal. Strateg. Manag..

[13]  Suzanne van den Bosch,et al.  Transition Experiments: Exploring societal changes towards sustainability , 2010 .

[14]  R.J.F. Hoogma,et al.  Experimenting with sustainable transport innovations : a workbook for strategic niche management , 1999 .

[15]  Frank Bruinsma,et al.  Managing the Transition to Renewable Energy , 2008 .

[16]  G. Dewulf,et al.  PPPs in Health: Static or Dynamic? , 2010 .

[17]  E. Pavolini,et al.  Restructuring the welfare state: reforms in long-term care in Western European countries , 2008 .

[18]  A. Enthoven.  Integrated delivery systems: the cure for fragmentation. , 2009, The American journal of managed care.

[19]  Rob Raven,et al.  What is protective space? Reconsidering niches in transitions to sustainability , 2012 .

[20]  F. Geels,et al.  Typology of sociotechnical transition pathways , 2007 .

[21]  U. Jørgensen.  Mapping and navigating transitions—The multi-level perspective compared with arenas of development , 2012 .

[22]  Harold D. Lasswell,et al.  The Policy Sciences , 1953 .

[23]  J. Rotmans,et al.  The practice of transition management: Examples and lessons from four distinct cases , 2010 .

[24]  François Béland,et al.  A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  Gerald Wistow,et al.  Development of integrated care in England and the Netherlands: managing across public-private boundaries. , 2003, Health policy.

[26]  B MilesMatthew,et al.  Qualitative Data Analysis , 2009, Approaches and Processes of Social Science Research.

[27]  Bert Meijboom,et al.  Demand-based Provision of Housing, Welfare and Care Services to Elderly Clients: From Policy to Daily Practice Through Operations Management , 2009, Health Care Analysis.

[28]  Jeremy N. Anderson,et al.  Estimates of complications of medical care in the adult US population , 2001, BMC health services research.

[29]  Hennie Boeije,et al.  Analysis in qualitative research , 2010 .

[30]  Marjolein C. J. Caniëls,et al.  Strategic niche management: towards a policy tool for sustainable development , 2008, Technol. Anal. Strateg. Manag..

[31]  B. Truffer,et al.  Sustainability transitions: An emerging field of research and its prospects , 2012 .