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

Listed author(s):
  • 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.

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

Volume (Year): 17 (2008)
Issue (Month): 2 ()
Pages: 221-233

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Handle: RePEc:wly:hlthec:v:17:y:2008:i:2:p:221-233
DOI: 10.1002/hec.1255
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  1. 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.
  2. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202.
  3. A S Fotheringham, 1984. "Spatial flows and spatial patterns," Environment and Planning A, Pion Ltd, London, vol. 16(4), pages 529-543, April.
  4. 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.
  5. A S Fotheringham, 1984. "Spatial Flows and Spatial Patterns," Environment and Planning A, , vol. 16(4), pages 529-543, April.
  6. 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.
  7. 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.
  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.
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