How to identify the drivers of patient inter-regional mobility in beveridgean systems? Critical review and assessment matrix for policy design & managerial interventions

Abstract

Decentralized, tax-funded health systems like Italian and Spanish ones reveal relevant internal patient flows, raising concerns in terms of equity, budget imbalances, and unexploited economies of scale at the regional and organizational level. However, policymakers lack effective tools to rapidly identify the causes of patient outflows in Beveridgean healthcare systems. We address the gap by conducting a critical review of the drivers of patient mobility. Elaborating on existing knowledge, we propose a concise, versatile assessment matrix to help policymakers in understanding the most relevant causes of mobility. Specifically, we identify three main categories of drivers: insufficient service availability, poor (perceived) quality, and regulatory issues. We include appropriate indicators to identify each driver, or mix of drivers. For each of them, we also propose specific policy and organizational responses. The applicability of the model is proven by an empirical test using the Italian national hospital discharge database for all inter-regional inpatient mobility flows. In addition to adding to previous contributions on mobility drivers by creating a model that informs policymakers’ understanding and actions, the paper provides an innovative approach to patient mobility by proposing a model that, for the first time, primarily focuses on the clinical discipline of the flows.

Inter-Regional Hospital Patients’ Mobility in Italy

“…The topic of inter-regional hospital healthcare mobility is very relevant for several reasons. First, it involves a large number of patients: in 2017 in Italy, the hospital discharges in mobility were 8.52%, which was higher compared to previous years [ 38 ]. Some flows can be considered physiological because they are due to movements between neighboring regions or to the size of catchment areas of high specialties.…”

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Implementing health system improvement: resources and strategies for interprofessional teams

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Inter-Regional Patients’ Migration for Hospital Orthopedic Intensive Rehabilitation: The Italian Experience

“…Willingness to travel from an area of residence to receive healthcare dates back centuries, and persists in modern times [ 1 , 2 ]. In fact, the growth in globalization, the development of new forms of political cooperation, technological evolution and refinement, and a growing international market for medical care are key factors for the rise in patients’ movement across international borders [ 3 ].…”