Traveling for care: Inter-regional mobility for aortic valve substitution in Italy

Regional incentives and patient cross-border mobility: evidence from the Italian experience

“…Within a framework of incomplete information (which is typical of the healthcare sector), the perceived quality of care can be easily influenced by the supply side, especially when the single hospital is offered incentives for attracting mobility. We have reported that the regions within the sample provide financial incentives to private accredited hospitals in order to attract patient inflows; there is evidence that some major private hospitals in the northern regions do informally promote their services in southern Italy and recruit patients through local specialists (6). This evidence supports our hypothesis of a more developed entrepreneurial activity by private providers, who react to budget restrictions by attracting non-resident patients (whose admissions are paid extra budget).…”

“…The two factors to be controlled for are: i) the type of mobility (boundary versus distance mobility) and ii) the type of destination (when hospitals of excellence are preferred, we can detect a "quality search" mobility). According to literature, "boundary CBM" is due to territorial proximity and to a certain extent is to be considered structural; whereas "distance CBM" is more quality-oriented (6,(11)(12)(13). The statistical investigation was carried out using specific parameters.…”

“…However, if they choose a private provider, this has to be accredited by the health system of the region in which it is established in order to be free of charge. The accreditation process in Italy has been implemented without a uniform design: some regions, mostly the ones located in northern or central Italy, have accredited (among others) well-provided hospitals, whereas very few southern regions (including Molise) did the same (5,6). As a consequence, there is a consistent annual flow of patients migrating from southern regions towards central-northern ones in search of hospital admissions: this phenomenon is significant, since 34.2% of total Cross-Border Mobility (CBM) moves in this direction, causing a considerable financial impact on regional budgets (6)(7)(8)(9)(10).…”

“…The accreditation process in Italy has been implemented without a uniform design: some regions, mostly the ones located in northern or central Italy, have accredited (among others) well-provided hospitals, whereas very few southern regions (including Molise) did the same (5,6). As a consequence, there is a consistent annual flow of patients migrating from southern regions towards central-northern ones in search of hospital admissions: this phenomenon is significant, since 34.2% of total Cross-Border Mobility (CBM) moves in this direction, causing a considerable financial impact on regional budgets (6)(7)(8)(9)(10). We aim to investigate whether the regional rules governing financial coverage of hospital admissions might have been used as an incentive to private providers in order to attract patients from other regions.…”

Cross-Border Mobility in Italy: Some Considerations in Response to the Recent Commentaries

“…The purchaser-provider contracts implemented with the quasi-market setting of the Italian NHS (1992-1993 reforms), facilitate these strategies, but, as Neri points out, their role is largely undervalued in the current analysis of the CBM phenomenon. Equally undervalued in the extant literature on the Italian CBM -a part from some exceptions 6 -are the stronger incentives for entrepreneurial and opportunistic behaviors standing for private hospitals compared to public ones. As Neri suggests, this topic deserves more investigation, and I agree on the usefulness of qualitative methods ("interviews to regional ministers and managers, private providers and any other subjects who could lead to a better understanding of drivers, features and consequences of patient mobility"), in order to corroborate the hypothesis of our analysis.…”