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The geography of hospital admission in a national health service with patient choice

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  • Daniele Fabbri
  • Silvana Robone

Abstract

Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for ‘trade’ in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enroless for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool. Copyright (C) 2010 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1639
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 19 (2010)
Issue (Month): 9 (September)
Pages: 1029-1047

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Handle: RePEc:wly:hlthec:v:19:y:2010:i:9:p:1029-1047

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

Related research

Keywords: patients' mobility ; hospital care ; gravity model ; spatial filtering ; Italian National Health Service ;

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Cited by:
  1. Roberto Ippoliti & Greta Falavigna, 2013. "Subjects’ decision-making process: an empirical analysis on patients’ mobility process and the role of pharmaceutical clinical research," International Review of Economics, Springer, Springer, vol. 60(3), pages 319-342, September.
  2. Amaral-Garcia, Sofia & Grembi, Veronica, 2014. "Curb your premium: The impact of monitoring malpractice claims," Health Policy, Elsevier, Elsevier, vol. 114(2), pages 139-146.
  3. Elenka Brenna & Federico Spandonaro, 2014. "Does federalism induce patients’ mobility across regions? Evidence from the Italian experience," DISCE - Working Papers del Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE) def9, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
  4. Sofia, AmaralGarcia & Veronica, Grembi, 2011. "Curb your premium! evaluating state intervention in medical malpractice insurance," MPRA Paper 32301, University Library of Munich, Germany.

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