What Drives Patient Mobility Across Italian Regions? Evidence from Hospital Discharge Data

Abstract

Patient mobility is often described as a marginal phenomenon in Europe since the overall number of patients that receive cross border care remains minor compared to the total population. However this phenomenon is increasing markedly. The process of globalization and the availability of medical information means that patients are more informed on treatment available well beyond their national boundaries. Patient empowerment implies that new generations will actively ask to be treated by the health care system that best meets their needs. A succession of individuals has already challenged the status quo and, in many cases, the European Court of Justice has upheld their arguments. At a political level, the EU has issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients' rights in cross border healthcare. This Directive has reformed the authorization procedures that were previously required to allow patients to go abroad to access health care services. In this respect, the Directive has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is a necessary condition to grant the people of Europe the same access to public sector health care services. The latter is a key instrument for an efficiently functioning ''single market'' ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health care services. The book is intended to provide a deeper understanding of the health market and stimulate reflection on European integration studies at a university level. The hypothesis for a fully coordinated European Health System will be investigated in great detail, highlighting the connected social and economic implications. This publication is a result of the Jean Monnet Lifelong Programme. Patient mobility for health within the EU borders is an issue of great interest in the European Union debate. The health side of European integration is generally undervalued but, on the contrary, it is crucial to fostering an effective internal market and to ensuring economic and social progress in Europe. Effective health integration in the European Union would represent a value-added resource in the path toward the effective mobility of people. For this purpose, it is extremely important that policy-makers of different European States agree on a unique international agreement to regulate the economic implications of patient mobility. v

Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review

“…For patient characteristics, 10 out of the 17 studies that reported results demonstrated that older patients were more likely to receive treatment from their nearest hospital (Balia et al, 2014; Basu, 2005; Beckert et al, 2012; Beukers et al, 2014; Cook et al, 2009; Fattore et al, 2014; Hanning et al, 2012; Howard, 2006; Roh & Moon, 2005; Varkevisser & van der Geest, 2007). Six out of nine studies demonstrated that patients in lower socioeconomic groups were more likely to receive treatment from their nearest providers (Beckert et al, 2012; Cook et al, 2009; Howard, 2006; Losina et al, 2007; Varkevisser et al, 2010; Varkevisser & van der Geest, 2007).…”

“…Different measures of provider quality were used in each of the studies (e.g., generic mortality rates, hospital infection rates, heart failure readmission rates, transplant failure rates, high volume surgical unit, hospital ranking). Other provider factors that are associated with a willingness to travel further are the availability of advanced technology (although not necessarily for the specialty in question) and a larger hospital (Balia et al, 2014; Escarce & Kapur, 2009; Fabbri & Robone, 2010; Ho, 2006; Roh & Moon, 2005). …”

“…Similarly patients were more likely to seek care within regions that were accessible by public and private transport (Balia et al, 2014; Fabbri & Robone, 2010; Fattore et al, 2014). …”

Regional regulators in health care service under quality competition: A game theoretical model

“…Clearly, if patients are free to choose the health care provider, expected satisfaction drives the individual choices about the provider, and patient mobility has to be expected. Patient mobility—both across the regions of any given country and even across countries—is a widely observed phenomenon indeed (see, e.g., Rosenmoller, McKee, & Baeten, ; Balia, Brau, & Marroccu, ); the phenomenon is expected to increase in next future, at least in the European Union in front of recent directives. This mobility, per se, is not a negative by‐product of the system; it associates with the aim of stimulating competition and increasing quality.…”

Spatial Effects in Hospital Expenditures: A District Level Analysis

“…Patients can choose any public or privately accredited facility in the country: mobility is in fact allowed not only across LHAs but also across Regions. The empirical evidence shows that interregional mobility involves a non-negligible share of patients and concentrates mainly on highly specialised treatments (Fabbri and Robone, 2010;Balia et al, 2014) Moreover, differences in waiting times for eligible treatments together with free patients' mobility generate incentives to shop around in search of faster responses not only for outpatient but also for inpatient services (Fattore et al, 2013).…”