Choice of hospital and long-distances: Evidence from Italy

Long-distance hospitalizations may represent an important phenomenon, especially with severe pathologies. In this work, we investigate patients’ elective admissions for cancers of the digestive system distinguishing between “local” hospitals (located in the region of residence) and “distant” hospitals (located in long-distances non-boundary regions). We model patient mobility towards alternative hospitals as a discrete choice process determined by geographical distance, clinical quality and other hospital-level characteristics and control for patients’ heterogeneity. We exploit data on admissions of patients residing in insular Italy, occurred in 2013 either locally or in central-northern hospitals, and estimate a willingness to travel of at least 14 ​km to be cured in a distant hospital for a quality increase from the 75th to the 25th percentile. Higher values are found for younger and more educated patients. Clinical quality does not affect the choice of local hospitals. Hospital choice significantly depends on characteristics that proxy hospital attractiveness, with differences between local and distant providers: commitment to research and private ownership show a positive role only for the latter.