Hospital choice with high long-distance mobility

We investigate long distance hospitalizations in a setting of patients with free mobility by studying the elective admissions of patients for cancers of the digestive system and distinguishing between local (located in the region of residence) and distant hospitals (located at very long distances in non-boundary regions). We used data from hospital discharge records of patients enrolled in the local healthcare systems of two insular Italian regions. We model mobility towards alternative hospitals as a discrete choice process determined by geographical distance, clinic quality and other hospital characteristics through a mixed logit model that controls for patients’ heterogeneity. Quality plays a relevant role in the choice of distant hospitals, whereas it does not affect the choice of local hospitals. Patients are willing to travel at least 14 km farther to be cured in a distant hospital with a clinical quality indicator that increases from the 75th to the 25th percentile. The willingness to travel is greater for younger and higher educated patients. Important differences emerge vis-à-vis the role of hospital pull factors. Our findings support the idea that long-distance mobility is a distinctive phenomenon that requires further study.