Due to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries-France and Sweden-where various policy measures aiming at developing and delivering integrated care can be identified: At the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double-local and national- A pproach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected.