Hospital Patients’ migration among Italian Regions

Abstract

Abstract Background At the beginning of the 2000s the federalization of the Italian National Health Service gave to the Regions greater financial and political responsibility: 21 Regional Health Services were set up with administrative and planning independence. They are in a potential competitive regime, since the citizens are free to choose their place of treatment. The aim of our research was to analyze fulfillment of needs for hospital services on site and Patients' migration to hospitals of other Regions. Methods We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2013 to 2017. The subjects of the analysis (catchment areas) were the hospital networks of Italian Regions. Interregional flows were carried out from data of Residents, Attractions and Escapes, which were developed through Attraction and Escape Indexes. Graphic representation was produced with Gandy's Nomogram. Results In the studied period, we observed an important decrease in hospitalizations and a simultaneous increase in interregional mobility. At the same time, admissions to hospital managed by Local Health Authorities and to Private Clinics increased. According to the Major Diagnostic Categories the main causes of hospitalizations in mobility were Musculoskeletal System And Connective Tissue Diseases (MDC 8), Cardiovascular System Diseases (MDC 5), Nervous System Diseases (MDC 1) and Digestive System Diseases (MDC 6). There were discrepancies between the Regions of Northern/Central Italy (higher Attraction Indexes) and Southern Italy (higher Escape Indexes). According to Gandy's Nomogram only nine Regions showed a good public hospital planning: Lombardy, A.P. of Bolzano, Veneto, Friuli V.G., E. Romagna, Tuscany, Umbria, Latium and Molise. Conclusions The North/Centre Regions have a public hospital planning able to be better to meet the care needs of their citizens and to attract Patients than the South ones. Key messages The study of Patients’ mobility is relevant in order to evaluate equity and quality of care provided by different Italian Regions. Patients' mobility has also an important economic implications.