The study of patients' mobility is useful for health planning and identifying deficiencies in care supply. The Italian Health Service, with 21 different regional realities, can be considered as a ...macrocosmic test bench. Our study aims: (1) to describe the trend of patients' hospital mobility across the Italian Regions; (2) to offer an immediate visual approach for decision making; (3) to identify some factors involved in patient's mobility.
Observational cross sectional study.
We used ordinary and day hospital discharge data from 1998 to 2014. The study was carried out using: (1) the Gandy's Nomogram (GN), a graphical tool that assesses the power of attraction and the escape's containment of hospital regional networks; (2) the vector analysis; (3) the trend analysis with Cuzik's test; (4) the panel data analysis, with multiple logistic regression model.
The mean number of annual admissions, in Italian hospitals, was 10,976,290, progressively decreasing from 2001 to 2014, and 7% of it occurred "in mobility". We have drawn the different paths of patients' mobility by Regions and observed critical situations almost in Regions of Southern Italy, compared with Regions of the Centre-North. Moreover we analyzed the factors implied in such mobility, highlighting that attraction is influenced by the hospitalization rate in private structures, by the percentage of graduates in the Regions, and by the number of hospital beds/10,000 inhabitants; while escapes are influenced by GDP per capita, by the number of hospital beds/10,000 inhabitants and by the sanitary expenses per capita of the Region.
We have shown the potentialities of the GN, applicable at micro level but also on a large scale in the analysis of patients' hospital mobility; and this, together with panel data analysis, can lead to a more conscious and effective health planning.
The paper “Regional incentives and patient cross-border mobility” received three commentaries, each adopting a different perspective on patients’ mobility issue. Starting with Neri,1 the author ...deeply examines the paper, by considering and commenting each step of the analysis.
Welfare systems are designed on geographical and membership boundaries. In terms of access to health care this implies that, as a general rule, only individuals residing in their national territory ...can obtain health care from providers located there. However, in the past few years medical tourism has grown at an explosive pace throughout the world and in Europe. Each year in fact a small, but significant number of European citizens seek medical treatment that is financed by their public insurer in another EU country. From an economic point of view, it is important to distinguish between the two following sources of patients' mobility: a regulated mobility, where the third payer decides to send patients abroad and patients' choice, where the patient himself decides to seek care abroad. In this article we show how the combined effect of restrictions to the use of health care, transfer prices, and mobility rules determine social welfare and its allocation between Regions. The results are quite interesting: if the price set for these patients is equal to the marginal cost of the more efficient Region, patients' mobility should be preferred to patients' choice. On the other hand, if the price is equal to the marginal cost of the less efficient Region, patient choice should be preferred. The other interesting result is a possible trade off between a static model where each Region chooses its level of cost/effectiveness and a more long-term situation, where patient mobility determines a common level for this parameter.
This paper proposes a decision-making process based on trust. Imagining the relationship between patients and physicians, based on the trust that the former put in the latter, which is the effect of ...experimental activities on the researcher’s (and/or medical center’s) reputation? Is it admissible to suppose a positive correlation between pharmaceutical clinical research and the return in terms of image for the medical care suppliers? This is the research question of this paper. Through empirical analysis, this work supports the proposed decision-making process and tries to answer this open issue. Considering Italy between 2002 and 2006, the analysis concerns the patients’ mobility process among regions and how pharmaceutical research can affect patients’ perception of the quality of medical treatments. Results suggest that mobility is clearly affected by a decision-making process based both on already existing good reputation (i.e., cognitive) and on confirmation of that image (i.e., behavioral). The latter is the phase in which the physician’s effort in the informed consent session of an experimental activity might make the difference in the reputation of the health care suppliers and, therefore, be a key factor in hospitalization choice.
In some countries the reform of public health care provision has been accompanied by a parallel process of devolution that has also entailed the organisation of health care becoming a regional ...competence. However, the application of fiscal federalism in the context of the provision of health care is not so straightforward due to the nature of the services involved. In this paper we will concentrate on the soft budget constraint policy which involves local authorities persistently running into a deficit. In our paper we explain such behaviour as the result of a game among local authorities where the more efficient one wants to increase its production beyond local needs; to do so it induces the less efficient one to make patient receive services outside their region in exchange for a reduction in the local tax rate. The lack of coordination between local objectives and total welfare means that this policy is optimal at local level, but inefficient at Central Government level. The outcome of such game is a welfare loss.
Every year 35% of the 10 million hospital admissions in Italy occurs outside the patients' Local Health Authority of residence. In this paper we look for explanation for this phenomenon and estimate ...gravity equations for "trade" in hospital care using a Poisson pseudo maximum likelihood method. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain the imports of hospital services increases with the size of the pool of enrollees. Moreover, the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effects played by the size of the pool of enrollees.
Every year 35% of the 10 million hospital admissions in Italy occurs outside the patients' Local Health Authority of residence. In this paper we look for explanation for this phenomenon and estimate ...gravity equations for "trade" in hospital care using a Poisson pseudo maximum likelihood method. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain the imports of hospital services increases with the size of the pool of enrollees. Moreover, the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effects played by the size of the pool of enrollees.
It is evaluated that, each year, 35% out of the 10 million hospital admissions in Italy take place outside the LHAs of residence. In our paper we try to give an explanation of this phenomenon making ...reference to the social gravity model of spatial interaction. We estimate gravity equations using a Poisson pseudo maximum likelihood method, as proposed by Santos-Silva and Tenreyro (2006). Our results suggest that the gravity model is a good framework for explaining the patient mobility phenomenon for most of the examined diagnostic groups. Our evidence suggests that the ability to contain the imports of hospital services increases with the size of the pool of enrolees. Moreover we find that the ability to export hospital services, as proxied by the ratio of export-to-internal demand, is U-shaped. Therefore our evidence suggests that there are scale effect played by the size of the pool of enrolees.
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