A Belgian reform towards an integrated care system for chronic patients: the ubiquity of knowledge

Countries all over Europe are currently facing budgetary pressures regarding their health care systems due to scientific progress, population ageing and a sharp rise in chronic diseases. In the European Union, chronic diseases are now the leading cause of death and the most important item of health expenditures (Schokkaert &Van de Voorde, 2011). In 2015, the Belgian Health Ministers launched a joint public health plan called “Integrated Care for Better Health” (2015) to bring about a transition from an institutional system to an integrated care system for patients with chronic diseases.
The authorities are nevertheless uncertain of the solutions to adopt in the Belgian context. Consequently, they have chosen to turn this plan into practice through 4-year pilot projects as part of an iterative and incremental implementation strategy. These iterative and incremental aspects entail a constant production and circulation of knowledge by and between actors involved in the co-construction process, between policy-makers and field actors responsible for policy implementation. As a result, this presentation focuses on concrete practices (preparatory meetings, plenary sessions, recourse to websites and forums, writing documents, etc.) that enact and stabilize knowledge that is produced, transformed and circulated between the different actors of the care production chain. These practices will be identified thanks to the methodological triangulation approach (policy documentary analysis, direct observation, semi-structured interviews).