Transferable enablers for community-based integrated care systems in ageing societies: a qualitative comparative analysis of Germany, Japan and Thailand

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Purpose Ageing populations place growing pressure on health and social systems in low- and middle-income countries (LMICs), where community-based integrated care systems (CBICS) offer coordinated health–social support. The transferability of high-income CBICS models to LMIC settings remains under-specified. This study examines which governance, financing and workforce enablers from Germany and Japan are plausibly relevant to strengthening Thailand's CBICS, using the six-dimension integrated care framework as an analytic lens. Design/methodology/approach We conducted a qualitative comparative case study based on 24 semi-structured interviews (Germany n = 5, Japan n = 10, Thailand n = 9) with administrators, coordinators, caregivers, advocates and academics. Interviews were transcribed in the source language, forward-translated into English and back-translated for a 20% sub-sample to check conceptual equivalence. Data were analysed thematically in ATLAS.ti using a hybrid inductive–deductive approach guided by the six integration dimensions. Five policy documents were used for triangulation, and member checking with nine participants supported credibility. Findings Germany's district conferences and subsidiarity-based welfare partnerships, Japan's statutory Long-Term Care Insurance and standardised care-manager role, and Thailand's temple-anchored community networks and volunteer workforce each combine enablers and maturity gaps across all six integration dimensions. Participants in all three countries described difficulties with workforce ageing, volunteer recruitment and financing volatility, with the profile of these difficulties differing by financing architecture. A conceptual three-phase pathway – foundational governance strengthening, blended financing enablement and workforce professionalisation with volunteer integration – is proposed as an organising device for LMIC adaptation; the qualitative evidence is consistent with this pathway and does not test it empirically. Practical implications Policymakers in LMIC settings may consider sequencing reforms in three phases – institutionalising local governance to manage the opportunity costs of informal care, introducing blended statutory and community-based financing to mitigate budget shocks, and professionalising the workforce while integrating volunteer networks – with sequencing calibrated to fiscal capacity and labour-market conditions. These implications are exploratory and require empirical validation through cost and outcome studies. Social implications Rebalancing coordination toward community actors and addressing social determinants may support more equitable ageing-in-place, reduce isolation and strengthen inclusive health promotion across diverse economic contexts. Originality/value The article contributes a structured comparative synthesis and a working transferability framework linking integrated care dimensions to an explicit health-economics logic (labour substitution, transaction-cost reduction, moral-hazard mitigation). The contribution is conceptual and exploratory: the article offers a structured cross-case synthesis and two heuristic devices – an Economic Logic Model and a Phased Pathway – that generate testable hypotheses for future empirical work. The article does not measure costs, utilisation, quality or equity outcomes, and does not claim to validate the economic mechanisms it advances.

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