Back to square one? Exploring boundary work by purchasers of health and social care

This multiple case study investigates how purchasers of health and social care (re)configure boundaries between sectors to incorporate a novel care model. Purchasers’ boundary work unfolded through (1) downplaying and expanding to assume joint responsibility and devise workarounds, (2) coalescing by sustaining workarounds and devising an experimental payment modality, and (3) limiting and reinforcing through instrumentalizing evidence and off-loading responsibility. Findings suggest that purchasers have greater potential to integrate health and social care than is typically assumed. Through workarounds, purchasers achieved temporary shifts in funding practices, demonstrating the capacity to enable integration between health and social care within restrictive frameworks.