Implementing policy integration: policy regimes for care policy in Chile and Uruguay

How are integrated policies implemented? In this paper we analyze two policies in Latin America aimed at securing integral care to children to show how the process of integration takes place over time. We study the process through which an ‘idea’ framed both the problem definition and the design features of the integrated policy over time; how the institutional arrangement continuously shaped the operation of the information flows, budget allocation and the relations among the organizations involved, and the role interests of different coalitions had on launching the strategy and, later, in keeping it integrated. We explain the design of care policies in Chile and Uruguay as integrated strategies, as they aligned several instruments from different sectors (health, education, and social development) to target children according to their specific, evolving needs. Based on official records, recent research and first-hand accounts of specialists and public officials, we conduct a comparative analysis of their implementation processes. We argue that their contrasting trajectories are not explained by differences in the policies’ design, but by variations in their policy regimes: how institutional arrangements, ideas and interests interacted with the policy to keep it integrated during the implementation. By doing so, we offer a more nuanced understanding of the forces that integrate or disintegrate a policy during their implementation. We employ a comparative case study approach for analyzing two integrated care policies for children in Chile and Uruguay, both testing existing theoretical conjectures about policy regimes and developing new ones about their role in implementing integrated policies and their adaptation over time.