Inter-Regional Hospital Patients’ Mobility in Italy

Abstract

Background: The federalization of the Italian National Health Service (NHS) gave administrative, financial, and managerial independence to regions. They are in reciprocal competition according to the “quasi-market” model. A network of independent providers replaced the state monopoly. The NHS, based on the Beveridge model in which citizens are free to choose their place of treatment, was consolidated. The aim of our research was to analyze the fulfillment of need for hospital services on site and patients’ migration to hospitals of other regions. Material and Methods: We analyzed data from 2013 to 2017 of Hospital Discharge Cards (HDCs) provided by the Ministry of Health. The subjects of the analysis (catchment areas) were the hospital networks of every Italian region. The study of flows was developed through Internal Demand Satisfaction, Attraction, Escape, Attraction, Absorption, and Escape Production indexes. Graphic representations were produced using Gandy’s Nomogram and Qgis software. Results: In the studied period, the mean number of mobility admission was 678.659 ± 3.388, with an increase of 0.90%; in particular, the trend for ordinary regime increased 1.17%. Regions of central/northern Italy have attracted more than 60% of the escapes of the southern ones. Gandy’s Nomogram showed that only nine regions had optimal public hospital planning (Lombardy, Autonomous Province of Bolzano, Veneto, Friuli V.G., Emilia-Romagna, Tuscany, Umbria, Latium and Molise). Conclusion: The central/northern regions appear more able to meet the care needs of their citizens and to attract patients than the southern ones.

Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)

“…Indeed, the population of the northern regions is generally more satisfied than in the past with the hospital care received; in contrast, in the central-southern regions, the level of satisfaction expressed by patients decreased from 1999 to 2017 in almost all regions [ 37 ]. Consequently, the percentage of patients treated in a different region from their home region increased from 7% in 2001 to about 8.5% in 2016, with the proportion of patients in the south choosing to be treated in another region being almost twice as high as that in the north [ 38 ]. Therefore, taking into account the fact that access to primary care is a strong predictor of the well-being of a patient, it is probable that a poorer well-being, related to a difficulty in gaining access to a routine consultation, may affect symptoms and mood, particularly in patients with OLP living with the fear of cancer development who should therefore be examined at least once a year [ 39 ].…”

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

“…This has an economic implication, including in the equity of the NHS. For the regions, there should be a priority to divide healthcare mobility for highly specialized care for low/medium complexity [ 27 , 29 ], to reduce the latter effect. Hospital orthopedic intensive rehabilitation falls within this category.…”

“…To describe the financial mobility flows absorbed and generated by each region, we used the Attraction Absorption and Escape Production Indexes [ 29 ].…”

“…To provide an immediate and graphical representation of the two indexes described, we used Quantum Gis software version 2.16.3 (Open Source Geospatial Foundation Project) [ 34 ] to generate cartographic maps. The stratification of colors was performed based on percentiles (≤10%; between 11% and 25%; between 26% and 50%; between 51% and 75%; between 76% and 90%; and ≥91%) [ 29 ]; thus, we obtained maps with six different color intensities.…”

“…In fact, regions that cannot provide a good quality of service will see their resources drained by payments made to other regions for the services used by their residents [ 25 , 26 , 27 ]. For these reasons, it is essential to analyze healthcare mobility since it is a fundamental tool for health policy and planning; it is an indirect indicator of perception of hospital quality (real/perceived) [ 28 , 29 ]. Patients’ mobility for hospital orthopedic intensive rehabilitation is a topic that has not yet been addressed in the literature.…”