IDEAS home Printed from
   My bibliography  Save this article

The analysis of a cardiological network in a regulated setting: a spatial interaction approach


  • Matteo Lippi Bruni

    (Department of Economics, University of Bologna, Bologna, Italy)

  • Lucia Nobilio

    (ASR-Agenzia Sanitaria Regionale, Regione Emilia Romagna, Italy)

  • Cristina Ugolini

    (Department of Economics, University of Bologna, Bologna, Italy)


We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA. Information is drawn from the regional administrative hospital discharge data (SDO) for the year 2002. We first use entropy indexes to investigate the spatial accessibility of the cardiological network. Secondly, by means of a gravity model estimated using Bayesian techniques we identify the determinants of patient flows in terms of demand and supply factors. Our results suggest that information on destinations is processed hierarchically and that agglomeration-like forces are dominant. Furthermore, although self-sufficiency of provision at the provincial level has been achieved to a large extent, there is still scope to improve the organisational efficiency of the network. Copyright © 2007 John Wiley & Sons, Ltd.

Suggested Citation

  • Matteo Lippi Bruni & Lucia Nobilio & Cristina Ugolini, 2008. "The analysis of a cardiological network in a regulated setting: a spatial interaction approach," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 221-233.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:2:p:221-233
    DOI: 10.1002/hec.1255

    Download full text from publisher

    File URL:
    File Function: Link to full text; subscription required
    Download Restriction: no

    References listed on IDEAS

    1. A S Fotheringham, 1984. "Spatial flows and spatial patterns," Environment and Planning A, Pion Ltd, London, vol. 16(4), pages 529-543, April.
    2. Belisle, S. & Dionne, G., 1985. "Accessibilite aux Ressources et Demande de Revascularisation du Myocarde," Cahiers de recherche 8531, Universite de Montreal, Departement de sciences economiques.
    3. A S Fotheringham, 1984. "Spatial Flows and Spatial Patterns," Environment and Planning A, , vol. 16(4), pages 529-543, April.
    4. Hodgkin, Dominic, 1996. "Specialized service offerings and patients' choice of hospital: The case of cardiac catheterization," Journal of Health Economics, Elsevier, vol. 15(3), pages 305-332, June.
    5. Burns, Lawton R. & Wholey, Douglas R., 1992. "The impact of physician characteristics in conditional choice models for hospital care," Journal of Health Economics, Elsevier, vol. 11(1), pages 43-62, May.
    6. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202.
    7. A S Fotheringham, 1983. "A new set of spatial-interaction models: the theory of competing destinations," Environment and Planning A, Pion Ltd, London, vol. 15(1), pages 15-36, January.
    8. Nobilio, L. & Ugolini, C., 2003. "Selective referrals in a `hub and spoke' institutional setting: the case of coronary angioplasty procedures," Health Policy, Elsevier, vol. 63(1), pages 95-107, January.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Simon Jones & Jessica Wardlaw & Susan Crouch & Michelle Carolan, 2011. "Modelling catchment areas for secondary care providers: a case study," Health Care Management Science, Springer, vol. 14(3), pages 253-261, September.
    2. S. Balia & R. Brau & E. Marrocu, 2014. "Free patient mobility is not a free lunch. Lessons from a decentralised NHS," Working Paper CRENoS 201409, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    3. repec:wly:hlthec:v:26:y:2017:i::p:63-77 is not listed on IDEAS
    4. Claudio Pinto, 2017. "Perceived quality and formation of inter-regional networks of health care migration," Advances in Management and Applied Economics, SCIENPRESS Ltd, vol. 7(3), pages 1-5.
    5. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.
    6. Fattore, Giovanni & Petrarca, Giuseppina & Torbica, Aleksandra, 2014. "Traveling for care: Inter-regional mobility for aortic valve substitution in Italy," Health Policy, Elsevier, vol. 117(1), pages 90-97.
    7. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26, pages 63-77, September.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:17:y:2008:i:2:p:221-233. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing) or (Christopher F. Baum). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.