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Do Harder Local Budget Constraints Affect Patient Mobility?

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Abstract

A recent article by Bordignon et al. (2020) looks at the experience of Financial Recovery Plans (FRPs) imposed on regional governments running large fiscal deficits in the management of Health Services, finding convincing evidence that FRPs led in Italy to a significant containment in health spending and almost entirely wiped out regional deficits. The article also suggests that FRPs did not produce any significant deterioration in the quality of health services and in citizens’ health. In this paper we reconsider the effects that FRPs may have produced on health services, by focusing on patient migration. By reframing the empirical analysis within the relevant strand of literature that considers migration as mainly driven by the supply side features of the healthcare systems (Levaggi and Zanola, 2004) and by considering the announcement effects related to this form of fiscal discipline, we estimate an increase in patient mobility in the range 15-18% as due to FRPs (18-25% when a commissioner is appointed). Our results suggest that the improvements in fiscal discipline may have widened the quality gap in the health services regionally delivered, with undesirable consequences in terms of increased disparities in the distribution of access opportunities to healthcare.

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  • Sergio Beraldo & Michela Collaro & Immacolata Marino, 2020. "Do Harder Local Budget Constraints Affect Patient Mobility?," CSEF Working Papers 580, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    • Handle: RePEc:sef:csefwp:580
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    References listed on IDEAS

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    1. Charles M. Tiebout, 1956. "A Pure Theory of Local Expenditures," Journal of Political Economy, University of Chicago Press, vol. 64(5), pages 416-416.
    2. Antonio Abatemarco & Massimo Aria & Sergio Beraldo & Francesca Stroffolini, 2020. "Measuring Disparities in Access to Health Care: A Proposal Based on an Ex-ante Perspective," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(2), pages 549-568, July.
    3. Massimo Bordignon & Silvia Coretti & Massimiliano Piacenza & Gilberto Turati, 2020. "Hardening subnational budget constraints via administrative subordination: The Italian experience of recovery plans in regional health services," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1378-1399, November.
    4. Beraldo, Sergio & Caruso, Raul & Turati, Gilberto, 2013. "Life is now! Time preferences and crime: Aggregate evidence from the Italian regions," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 47(C), pages 73-81.
    5. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    6. Francese, Maura & Piacenza, Massimiliano & Romanelli, Marzia & Turati, Gilberto, 2014. "Understanding inappropriateness in health spending: The role of regional policies and institutions in caesarean deliveries," Regional Science and Urban Economics, Elsevier, vol. 49(C), pages 262-277.
    7. Giovanni Perucca & Massimiliano Piacenza & Gilberto Turati, 2019. "Spatial inequality in access to healthcare: evidence from an Italian Alpine region," Regional Studies, Taylor & Francis Journals, vol. 53(4), pages 478-489, April.
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    Cited by:

    1. Abatemarco, Antonio & Aria, Massimo & Beraldo, Sergio & Collaro, Michela, 2023. "Measuring Access and Inequality of Access to Health Care: a Policy-oriented Decomposition," CELPE Discussion Papers 164, CELPE - CEnter for Labor and Political Economics, University of Salerno, Italy.

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    More about this item

    Keywords

    Recovery Plans; Patient mobility; Equality of access to healthcare;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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