How are integrated policies implemented? In this paper we analyze two policies in Latin America aimed at securing integral care to children to show how the process of integration takes place over time. We study the process through which an ‘idea’ framed both the problem definition and the design features of the integrated policy over time; how the institutional arrangement continuously shaped the operation of the information flows, budget allocation and the relations among the organizations involved, and the role interests of different coalitions had on launching the strategy and, later, in keeping it integrated. We explain the design of care policies in Chile and Uruguay as integrated strategies, as they aligned several instruments from different sectors (health, education, and social development) to target children according to their specific, evolving needs. Based on official records, recent research and first-hand accounts of specialists and public officials, we conduct a comparative analysis of their implementation processes. We argue that their contrasting trajectories are not explained by differences in the policies’ design, but by variations in their policy regimes: how institutional arrangements, ideas and interests interacted with the policy to keep it integrated during the implementation. By doing so, we offer a more nuanced understanding of the forces that integrate or disintegrate a policy during their implementation. We employ a comparative case study approach for analyzing two integrated care policies for children in Chile and Uruguay, both testing existing theoretical conjectures about policy regimes and developing new ones about their role in implementing integrated policies and their adaptation over time.

综合政策如何落实？在本文中，我们分析了拉丁美洲旨在确保儿童得到全面照顾的两项政策，以展示融合过程如何随着时间的推移而发生。我们研究“想法”随着时间的推移界定问题定义和综合政策设计特征的过程；制度安排如何不断影响信息流的运作、预算分配和相关组织之间的关系，以及不同联盟的角色利益对战略的启动以及随后保持战略一体化的影响。我们将智利和乌拉圭的护理政策设计解释为综合战略，因为它们结合了不同部门（健康、教育和社会发展）的多种工具，根据儿童具体的、不断变化的需求来针对儿童。根据官方记录、最近的研究以及专家和公职人员的第一手资料，我们对其实施过程进行了比较分析。我们认为，它们截然不同的轨迹并不是由政策设计的差异来解释的，而是由政策体制的差异来解释的：制度安排、思想和利益如何与政策相互作用，以使其在实施过程中保持一体化。通过这样做，我们可以更细致地了解政策实施过程中整合或瓦解政策的力量。我们采用比较案例研究方法来分析智利和乌拉圭的两项儿童综合保育政策，这两项政策都测试了有关政策制度的现有理论猜想，并就其在实施综合政策中的作用及其随着时间的推移进行的调整制定了新的理论猜想。