Empirical archetypes of transformative health and care ecosystems in Europe

Background

Ecosystem approaches are increasingly promoted to address siloed health and care service systems (Beirão et al, 2017). Yet, empirical insights remain fragmented and non‑cumulative. This study addresses this gap by asking: What ecosystem models are employed to pursue system‑level transformation in European health and care systems toward different policy goals?

Methods

The study applies a multiple mini case study (MMCS) design of 42 health and care ecosystem cases collected in the framework of the European Partnership programme “Transforming Health and Care Systems (THCS)”. The data consists of systematically completed case templates, complemented with document data. Through structured qualitative coding and in-depth cross-case analysis, clusters of ecosystem features were identified.

Preliminary Findings

Based on the identified clusters, four archetypes of transformative health and care ecosystems were formed: 1) regional service integration ecosystems restructuring care pathways across organizations, 2) innovation and learning ecosystems for experimentation, scaling, or collective capacity building; 3) community-centered ecosystems reorienting care toward prevention and holistic wellbeing through multi-actor collaboration, and 4) value‑based collaborative ecosystems reconfiguring incentives and risk‑sharing through market‑oriented arrangements. Architypes and their subtypes showcase differences in ecosystem objectives, degree of institutionalization, governance, funding mechanisms, and actor constellations.

Conclusions

The study contributes to health services and systems research by providing a comparative empirical overview of how ecosystem‑based transformation is currently organized. For public health policy, the typology based on the archeypes provides a practical analytical tool for ecosystem design, steering, and assessment, helping to align policy instruments with transformation objectives.

Key messages

• The study develops a typology of transformative health and care ecosystem models, demonstrating different approaches to institutionalization, governance, funding mechanisms, and actor constellations.

• Drawing on 42 ecosystem cases across Europe, the study offers a comparative empirical overview that advances ecosystem theory in health systems research and informs policy on on system transformation.