Does federalism induce patients’ mobility across regions? Evidence from the Italian experience (original) (raw)
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Regional Incentives and Patient Cross-Border Mobility: Evidence from the Italian Experience
2015
Background In recent years, accreditation of private hospitals followed by decentralisation of the Italian National Health Service (NHS) into 21 regional health systems has provided a good empirical ground for investigating the Tiebout principle of “voting with their feet”. We examine the infra-regional trade-off between greater patient choice (due to an increase in hospital services supply) and financial equilibrium, and we relate it to the significant phenomenon of Cross-Border Mobility (CBM) between Italian regions. Focusing on the rules supervising the financial agreements between regional authorities and providers of hospital care, we find incentives for private accredited providers in attracting patient inflows. Methods The analysis is undertaken from an institutional, regulatory and empirical perspective. We select a sample of five regions with higher positive CBM balance and we examine regional regulations governing the contractual agreements between purchasers and providers of hospital care. According to this sample, we provide a statistical analysis of CBM and apply a Regional Attraction Ability Index (RAAI), aimed at testing patient preferences for private/public accredited providers. Results We find that this index is systematically higher for private providers, both in the case of distance/boundary patients and of excellence/general hospitals. Conclusion Conclusions address both financial issues regarding the coverage of regional healthcare systems and equity issues on patient healthcare access. They also raise concerns on the new European Union (EU) directive inherent to patient mobility across Europe.
Health Econometrics and Data Group Working Papers, 2008
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.
Hospitals’ strategic behaviours and patient mobility: Evidence from Italy
Socio-Economic Planning Sciences, 2021
The aim of this study is to explore hospitals' behaviours in attracting extra-regional patients and to investigate the effects of these behaviours on the quality of care to resident patients in a context where choices by regional patients are constrained by a budget cap and extra-regional patients are unconstrained source of revenue. Empirical results suggest that, controlling for hospital fixed effects, patients' demographic and health characteristics, hospitals use waiting times and length of stay to attract exra-regional patients. Regional patients admitted in both private and public hospitals with higher proportions of extra-regional patients show lower mortality rates and reimbursement costs. These results suggest that competition increases the quality of care and reduces costs through spillover effects produced by the market for extra-regional patients. Finally, the pattern of reimbursement asked for extra-regional care generates a financial flow in favour of richer regions, exacerbating the north-south gradient in the Italian NHS.
Patients' migration across regions: the case of Italy
Applied Economics, 2004
The purpose of this paper is to analyse patient's mobility across Italian regions. A modified gravity model of patient migration is specified and estimated using panel observations covering mobility and other main regional quality indicators over the period 1994-1997. Despite the high level of aggregation due to data constraints, the empirical findings show that in Italy there is wide scope for quality-driven mobility while income determines the quality of the service offered.
How health care regionalisation in Italy is widening the North–South gap
Health Economics, Policy and Law, 2014
The Italian National Health Service began experimenting with a significant regionalisation process during the 1990s. The purpose of this article is to assess the effects that this regionalisation process is having on the rift between the north and the south of the country. Has the gap between the health care systems of the northern and southern regions been increasing or decreasing during the 1999-2009 decade? Three indicators will be utilised to answer this question: 1) the level of satisfaction expressed by the citizens towards the regional hospital system; 2) the mobility of the patients among regions; 3) the health care deficit accumulated by the individual regions. On the basis of these three indicators, there is evidence to conclude that, during the decade under study, the gap between the North and the South, already significant, has increased further.
The geography of hospital admission in a national health service with patient choice
Health Economics, 2010
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 . 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.
Health Care Regionalization in Italy
This work aims at bringing into focus the main change that the Italian National Health Service has been undergoing over the past twenty years, namely the gradual transfer of jurisdiction from the central government to the regions. Starting with the 1992-1993 reform the regions were indeed granted broad latitude in organizing health care services in their own territories. The individual regions have thus been able to choose among various organization models, differing from each other in a variety of aspects. During the past years, frictions between central government and regions have been frequent. The central government has often accused the regions of being financially irresponsible and overrunning systematically the spending levels assigned to them; for their part, the regions have regularly accused the central government of allocating an inadequate amount of resources to the National Health Service. Italy (not only Italian citizens but also foreigners who hold a permit to stay in the country) a broad range of health services. The benefits package provided by the SSN includes preventive services, hospital care, family doctors and specialist services. Dental care, rehabilitation and vision care areon the contrarylargely excluded.