Introduction and objective: The epidemiological and demographic transition requires the health services to make a shift from hospital-centered care to Primary Health Care. Italy, since 2007, is experimenting the implementation of "Health Homes", health units that should constitute a reference point for social and health territorial services integration. The first national directives provided structural criteria that were subsequently followed by functional criteria. The Emilia-Romagna Region has already implemented 84 health homes, 7 of which in the province of Ferrara. This province is subdivided in 24 municipalities characterized by different ecosocial, epidemiological and cultural aspects. To develop effective but equal health services in such different environments adaptive policies are needed. Aim of this study is to evaluate the ongoing experimentation of adaptive policies in three health homes of Ferrara Local Health Unit Authority.
Methods: The experimentation is taking place in three Health Homes, already involved in a situated learning project coordinated by the Centre for International Health of the University of Bologna. One of the Health Homes is situated in the Ferrara urban area (132.000 inhabitants) and the other two in rural areas (Portomaggiore and Copparo, around 14.000 inhabitants each). The analysis was conducted through qualitative methods (meeting reports and field notes analysis).
Results: In the three health homes, vertical fragmentation (from professionals to managers) appeared as major problem. In times of financial crisis, the need of expenditure control requires from health managers centralization and standardization as well as a strict procedural control, worsening vertical fragmentation. Specific group-based, intra-institutional activities were organized in each health home to bridge vertical fragmentation and to help in rebuilding intra-institutional as well as inter-institutional networks, facilitating effective adaptive policies drafting.
Conclusions: Adaptive policies need a precise set of institutional and professional skills and competences as well as organizational structures and community support.