The Geography of Hospital Admission in a National Health Service with Patient Choice

44 Pages Posted: 28 May 2009 Last revised: 27 Sep 2010

See all articles by Daniele Fabbri

Daniele Fabbri

University of Bologna - Department of Economics

Silvana Robone

University of York - Centre for Health Economics

Multiple version iconThere are 2 versions of this paper

Date Written: May 2010

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 enroless for all LHAs but 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.

Keywords: patients mobility, hospital care, gravity model, Italian National Health Service

JEL Classification: I11, C25

Suggested Citation

Fabbri, Daniele and Robone, Silvana, The Geography of Hospital Admission in a National Health Service with Patient Choice (May 2010). Available at SSRN: https://ssrn.com/abstract=1411070 or http://dx.doi.org/10.2139/ssrn.1411070

Daniele Fabbri (Contact Author)

University of Bologna - Department of Economics ( email )

Piazza Scaravilli 2
Bologna, 40126
Italy

Silvana Robone

University of York - Centre for Health Economics ( email )

York YO10 5DD
United Kingdom
0044 1904 321452 (Phone)

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