Path Dependence and Integrated Care

Promoting Integrated Care through a Global Treatment Budget

“…Generally, the innovation must prove itself in a health policy environment with strong forces of inertia in the regular system. It is characterised not only by institutional complexities and dominating tendencies towards status quo preservation, but even by path dependencies that make disruptive innovations practically impossible [ 29 46 ]. Moreover, the incentive in current psychiatric care system lies largely in the expansion of relatively well remunerated inpatient care.…”

“…Despite the above-mentioned overall positive experiences to date and the evidence for manifold improvement of mental health care, the GTB has not prevailed in mainstream mental health care in Germany; after more than 15 years of testing, less than 5% of care regions have followed this model [ 13 ]. The sluggish implementation of complex new health care models is not new; it is attributed to the models’ complexity per se, path dependencies in the health care system, and lack of governance knowledge [ 29 30 ].…”

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“…So ist es naheliegend, bei einer beobachteten starken Wandlungsresistenz eine Pfadabhängigkeit zu vermuten. Diese Vermutung wird jedoch bislang eher selten durch die Darstellung der zur Pfadabhängigkeit führenden Ursachen -kritische Ereignisse und selbstverstärkende Mechanismen -untermauert (Auschra/Sydow 2021). Dies kann in den meisten Fällen nur durch eine detaillierte, oft rückblickende Analyse erreicht werden -was insbesondere bei der Untersuchung von Pfadabhängigkeiten auf systemischer Ebene sehr aufwändig ist.…”

Defining Pooled’ Place-Based’ Budgets for Health and Social Care: A Scoping Review

“…As mentioned in the introduction of this study, pooled budget funds entail the creation of a single administrative, legal, and organisational system in order to align providers' incentives and overcome agency problems in the way health and social care is organised and delivered. Therefore, as the path dependency [142] theory also suggests, implementing these changes may be context dependent on a series of contingencies that have occurred in a specific place at a particular point in time. Another set of initial conditions might have produced different outcomes.…”