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Hospitals' Strategic Behaviours and Patient Mobility: Evidence from Italy


  • Paolo Berta

    () (Università di Milano-Bicocca)

  • Carla Guerriero

    () (Università di Napoli Federico II and CSEF)

  • Rosella Levaggi

    () (Università di Brescia)


The aim of this study is to explore hospitals' behaviours in attracting extra-regional patients and to investigate the effects of these behaviours on the quality of care to resident patients in a context where choices by regional patients are constrained by a budget cap and extra-regional patients are unconstrained source of revenue. Empirical results suggest that, controlling for hospital fixed effects, patients' demographic and health characteristics, hospitals use waiting times and length of stay to attract exra-regional patients. Regional patients admitted in both private and public hospitals with higher proportions of extra-regional patients show lower mortality rates and reimbursement costs. These results suggest that competition increases the quality of care and reduces costs through spillover effects produced by the market for extra-regional patients. Finally, the pattern of reimbursement asked for extra-regional care generates a financial flow in favour of richer regions, exacerbating the north-south gradient in the Italian NHS.

Suggested Citation

  • Paolo Berta & Carla Guerriero & Rosella Levaggi, 2020. "Hospitals' Strategic Behaviours and Patient Mobility: Evidence from Italy," CSEF Working Papers 555, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
  • Handle: RePEc:sef:csefwp:555

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    Hospital competition; patient mobility; mixed market; quality of care.;

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • D6 - Microeconomics - - Welfare Economics
    • C70 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - General

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