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Does federalism induce patients’ mobility across regions? Evidence from the Italian experience

Author

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  • Elenka Brenna

    () (Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore)

  • Federico Spandonaro

    () (Università degli Studi di Roma "Tor Vergata")

Abstract

In recent years, the accreditation of private hospitals followed by the decentralisation of the Italian NHS into 21 regional health systems, has furnished a good empirical ground for investigating the "voting with their feet" Tiebout principle. We consider the competition between public and private hospitals - and the rules supervising the financial agreements between regional authorities and providers of hospital care - as a potential determinant factor for cross border mobility in the Italian NHS. The model we propose considers an institutional variable set at a regional level that, ceteris paribus, succeeds in driving CBM flows towards accredited private hospitals. We assume that some northern and central regions accredited private providers not only to meet the internal need of hospital care, but also with the aim of attracting patients' inflows from other regions, particularly from the South of Italy, where the services supplied do not cover such a broad range of hospital specialization and/or do not guarantee the same perceived quality of care. The geographical gradient in this context is considerable: in 2011 the southern regions show a negative balance of - 1.046 billion euro for patients' migration, while the northern ones report a surplus of 863 million euro. Evidence, both from the normative inspection and the statistical analysis, suggests the presence of strategic incentives provided by some regions with the twofold objective of accrediting a good quality health system and contextually overcoming the risk of production excess by driving financial resources from patients' inflows.

Suggested Citation

  • 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 def009, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
  • Handle: RePEc:ctc:serie1:def009
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    File URL: http://dipartimenti.unicatt.it/economia-finanza-def009.pdf
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    References listed on IDEAS

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    Cited by:

    1. Rosario Crinò & Laura Ogliari, 2015. "Financial Frictions, Product Quality, and International Trade," DISCE - Working Papers del Dipartimento di Economia e Finanza def030, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    2. Osea Giuntella & Jakub Lonsky & Fabrizio Mazzonna & Luca Stella, 2020. "Immigration Policy and Immigrants’ Sleep. Evidence from DACA," DISCE - Working Papers del Dipartimento di Economia e Finanza def096, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    3. 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.

    More about this item

    Keywords

    patient choice; hospital accreditation; competition; cross border mobility; federal NHS.;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H3 - Public Economics - - Fiscal Policies and Behavior of Economic Agents

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