Hospitals’ strategic behaviours and patient mobility: Evidence from Italy

Abstract

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.

The beaten paths effect on patient inter‐regional mobility: An application to the Italian NHS

“…We believe that family and social ties between past migrants and people still leaving in the same region of origin are exploited by private hospitals for financial motivations, because in Italy extra‐regional patient flows are reimbursed out of regional budgets; that is, they are a pull factor in HM. This is similar to the evidence provided by Berta et al (2021) when investigating the impact of extra‐regional patient flows on the waiting times of local patients: they find longer waiting times for the local patients, in comparison with extra‐regional ones, and explain it for financial motivations. We highlight another pull factor present in HM, in this case for private hospitals.…”

“…Similarly for Campania: it is a net importer (À27,969), and about one in every three patients seeks admission outside the region (health emigrants account for almost 30% of local admissions). 5 Berta et al (2021) show that Italian hospitals might have financial incentives to shorten strategically the waiting times of extra-regional patients. This will attract higher in-migration flows and, in turn, higher reimbursement.…”

Inter-Regional Hospital Patients’ Mobility in Italy

“…In fact, residents of less populated areas, especially if they are frail elderly, where the competition between healthcare facilities is weak, tend to choose what the system offers. However, hospitals (especially private ones), usually located in populated areas, generally offer longer lengths of stay and more flexible waiting lists to attract this type of patient [ 24 , 25 , 26 ]. It has been proved [ 27 ] that a higher income is associated with a greater willingness to travel, although there is a saturation point (distance) beyond which the income effect is greatly reduced [ 28 ].…”

Should I wait or should I go? Travelling versus waiting for better healthcare

“…Focusing on the Italian case, more recent contributions have investigated patients' migrations across jurisdictions by examining the push and pull factors and the financial consequences of patients seeking care out of their catchment area (e.g. Fabbri and Robone, 2010;Balia et al, 2014Balia et al, , 2018Balia et al, , 2020Berta et al, 2021).…”