Organizing healthcare in remote rural areas: comparing experiences of service delivery redesign

Background: The debate about closing small hospitals located in rural and/or remote areas is not novel. However, demographic and epidemiologic trends, together with technologic advances are associated with emerging clusters of complex patients. Rural and/or remote areas tend to anticipate the national demographic forecasts. Therefore, concerns about appropriate health services accessibility are legitimate. Method: We selected three cases of health service delivery in rural and/or remote areas resulting from reorganization of previously existing hospitals: two cases are located in Switzerland and one in Italy. Semi-structured interviews were conducted in each organization, where researchers collected also official documents. Each researcher coded the data independently. Then codes were iteratively discussed to identify common dimensions suitable for comparison across the cases. Discussion: The comparative analysis showed that the apparent contrast between social/health and policy/managerial instances has reached a point of equilibrium. The reorganization processes can be interpreted as an optimization of the coordination of the health and social resources available within and close to the community. The existence of a leading reference subject, human resource management, and logistic arrangements played an important role in the success of the initiatives.