The geography of hospital admission in a national health service with patient choice

Health Economics
Daniele Fabbri, Silvana Robone

Abstract

Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for 'trade' in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enrollees for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool.

References

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Citations

Jun 23, 2015·Health Economics·Sofia Amaral-GarciaVeronica Grembi
Sep 24, 2013·Health Policy·Sofia Amaral-Garcia, Veronica Grembi
Apr 15, 2014·Health Policy·Giovanni FattoreAleksandra Torbica
Jul 1, 2016·Medical Care Research and Review : MCRR·Ajay AggarwalJan van der Meulen
Apr 3, 2010·BMC Medical Informatics and Decision Making·Giovanni MaifrediUmberto Gelatti
Sep 1, 2019·BMC Health Services Research·Ruijie ZhangFang Xia
Sep 25, 2017·Health Economics·Matteo Lippi Bruni, Irene Mammi
Oct 10, 2020·Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration·Alberto RicciFrancesco Longo

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