Abstract

The paper analyses the implementation of 2021-22 national primary and community care reform in Lombardy and Marche. These Italian Regions are associated to different models of Regional healthcare systems. After having reconstructed the institutional arrangements developed in the two cases since the 1990s and earlier, the authors focus on the creation of the new multiprofessional primary care units, called Community Houses (CHs). CH implementation highlights at least four critical issues, which are illustrated in the paper. Although the organisation and regulation of the two healthcare systems depend on the solutions which will be provided to these issues, the interplay between agency factors and institutional legacy are making the two systems more similar to each other, in unexpected ways. The analysis of current trends in other Regional healthcare systems in Italy is necessary to better understand causes, extent and general implications of these changes, which could bring to a revision in the typologies of the Regional healthcare systems.