Spatial Effects in Hospital Expenditures: A District Level Analysis

Abstract

Geographical clusters in health expenditures are well documented and accounting for spatial interactions may contribute to properly identify the factors affecting the use of health services the most. As for hospital care, spillovers may derive from strategic behaviour of hospitals and from patients' preferences that may induce mobility across jurisdictions, as well as from geographically-concentrated risk factors, knowledge transfer and interactions between different layers of care. Our paper focuses on a largely overlooked potential source of spillovers in hospital expenditure: the heterogeneity of primary care providers' behaviour. To do so, we analyse expenditures associated to avoidable hospitalisations separately from expenditures for highly complex treatments, as the former are most likely affected by General Practitioners, while the latter are not. We use administrative data for Italy's Region Emilia Romagna between 2007 and 2010. Since neighbouring districts may belong to different Local Health Authorities (LHAs), we employ a spatial contiguity matrix that allows to investigate the effects of geographical and institutional proximity and use it to estimate Spatial Autoregressive and Spatial Durbin Models.

How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna

“…In such a setting, where regulated prices are used to allocate public funding and where patients have free choice of public sector treatment that is largely free of charge at the point of delivery, hospitals might have an incentive to raise quality. This may allow to retain local patients, thereby avoiding losses due to cost duplication, and to attract patients residing outside the hospital catchment area as a way of raising revenues (Lippi Bruni & Mammi, ). In the following, we present a theoretical framework based on the Bloom, Propper, Seiler, and Van Reenen () model to illustrate the behaviour and the underlying incentive structure of the hospital decision makers.…”

Should I Wait or Should I Go? Travelling Versus Waiting for Better Healthcare

“…We study patients' mobility in the Italian National Health Service (NHS) where secondary care is free of charge and patients' costs stem mainly from travel distance and waiting times. Hospitals retain incentives to attract patients, as they receive reimbursement through a Diagnosis Related Group (DRG)-based Prospective Payment System (PPS) (Lippi Bruni and Mammi, 2017;Cappellari et al, 2016). We analyse hospital choice in response to changes in waiting times and clinical quality within hospitals over time by using patient-level data on elective Percutaneous Transluminal Coronary Angioplasty (PTCA) for the period 2008-2011.…”