Reconstruction of policy process Combined Lifestyle Intervention in care package

The implementation of a Dutch policy package concerning the Combined Lifestyle Intervention, an integrated approach to preventing obesity risks to health coaching patients on changing their eating and activity patterns, took more than ten years. The aim of this research is to investigate why it took so long, and to draw lessons about the policy process, coordination and institutional organisation of prevention in healthcare settings.

From a public governance perspective we seek to answer three questions:

1. What design choices have been made making up the policy package of the CLI?
2. Which developmental stages, argumentation and actors were decisive for the achievement of this package?
3. Which lessons can be drawn from the CLI positioning in institutional systems for health and social care, and how can the coordination of cooperation for prevention in healthcare be improved using arrangements of New Public Governance?

This qualitative historical institutional analysis draws on political and policy archive documents, research and meeting reports between 2007 and 2019, and additional semi-structured interviews with 15-20 key stakeholders in the CLI national policy preparations. Analysis follows a logic of ‘backward mapping’, reconstructing the policy process and tracing explanations for policy delay and progress.

The discussion of results will include a reflection on how to move from government to market to governance, and from a predominantly competitive incentive structure to a complementary cooperative incentive structure for healthcare insurers, municipalities providing social support, general practitioners assessing and referring patients for CLI, and lifestyle coaches conducting the interventions.