Health and social care integration: fixing a fixed service ecosystem for value co-creation

In response to increasingly complex needs and tightening fiscal constraints, integration has led to changes in governance arrangements and joint service delivery. Applying a service ecosystem, a holistic view is presented to discuss the interconnectedness between the domains of the health and social care ecosystem, including their unique and shared contexts and the various actors and institutions involved. However, our analysis also exposes important power dimensions regarding how the service ecosystem is framed and the actors acknowledged as involved in value co-creation. In response, three interdependent types of integration (structural, institutional, and relational) are proposed.