Tim Radney explains the idea behind Azure SQL Database Managed Instances:
Managed Instances were first introduced at the Microsoft Build conference in Spring 2017, and so far the preview has been limited to a small number of customers and consultants. Managed Instances can be considered a hybrid between a full version of SQL Server and Azure SQL Database. Single and elastic databases are built upon a database-scoped programming model and Managed Instances are built on an instance-scoped programming model. This makes Managed Instances more compatible with on-premises SQL Server.
Managed Instances provide much more of a feel of an on-premises SQL Server, yet are built on the same infrastructure as Azure SQL Database. What sets it apart from Azure SQL Database is that it presents an entire SQL Server instance to the customer. In Azure SQL Database, you configure a server, which is really a container, and then can have multiple databases in that server, but they can’t easily talk to one another. With Managed Instances, all databases within the instance are on the same actual SQL Server, so you have full support for cross-database queries. This is a huge feature for many applications that otherwise were not a good fit for Azure SQL Database, and I think that’s going to allow many more SQL Server applications to move into the cloud.
Managed Instances has the potential to make an Azure migration realistic for many companies sticking to the on-prem product or managing a bunch of IaaS VMs.