What drives patient mobility across Italian regions? Evidence from hospital discharge data.

This chapter examines patient mobility across Italian regions using data on hospital discharges that occurred in 2008. The econometric analysis is based on Origin-Destination (OD) flow data. Since patient mobility is a crucial phenomenon in contexts of hospital competition based on quality and driven by patient choice, as is the case in Italy, it is crucial to understand its determinants. What makes the Italian case more interesting is the decentralization of the National Health Service that yields large regional variation in patient flows in favor of Centre-Northern regions, which typically are 'net exporters' of hospital treatments. We present results from gravity models estimated using count data estimators, for total and specific types of flows (ordinary admissions, surgical DRGs and medical DRGs). We model cross-section dependence by specifically including features other than geographical distance for OD pairs, such as past migration flows and the share of surgical DRGs. Most of the explanatory variables exhibit the expected effect, with distance and GDP per capita at origin showing a negative impact on patient outflows. Past migrations and indicators of performance at destination are effective determinants of patient mobility. Moreover, we find evidence of regional externalities due to spatial proximity effects at both origin and destination.