Hospital patients mobility trends among the Italian regions: 1998-2008

Background The health mobility is an increasingly debated issue in the European arena under the European Union directive on cross- border patients migration. The Italian health system, due to its characteristics of administrative and fiscal federalism, is well suited to the analysis of the dynamics of interregional flows of patients. Our study aims to analyze time series patient- s’mobility among the 21 among Italian regions. Methods We used hospital discharge data obtained from the Ministry of Health, ranging from 1998 to 2008. The information collected for each of the 19 Italian regions and the two autonomous provinces of Bolzano and Trento were: admission of residents in their regional hospitals (R); admission to hospitals of patients ‘‘attracted’’ from other regions (A); admission of residents ‘‘escaped’’ in other regions (E). The data were grouped into two time series: from 1998 to 2002 and from 2003 to 2008 (1 regional administrative mandate is 5 years long). For the statistical analysis of time trends we used the non-parametric test of Cuzick. Significance was set at P < 0.05. Results 13/21 Regions changed their R trends: only some, placed in North Italy (Piedmont, V.Aosta, Trento, Friuli, Marche) had an increase. 12/21 Regions changed the A trend but only Calabria had a reduction one. 11/21 Regions changed the E trend: in 4 there was an increase. Conclusions The reduction of E could be read as a regain of the loses (increase demand satisfaction and/or improvement of health care performances) which were previously experienced. An increase of A could be read as a better offer; an increase of R identifies a regain in satisfying the inner demand of regional residents and/or improvements of the health care system. More significant is the jointly interpretation of R, E and A which made possible to identify several scenarios, for example good policy is when we found attractiveness ability trend, without the loss of inner residents. This scenario seems to have generally occurred in Northern Italy (for example Piedmont, V.Aosta, Trento, Friuli). Other Regions showed an increase of E and a reduction of R (Veneto, Tuscany, Umbria and Abruzzo). This condition was more critical. Apulia and Sardinia did not show significant variations. Key messages Patients’ mobility is a proxy of health policy. The European microcosm of the italian regions showed that areas mainly located in Northern increased local health care demand’satisfaction, while others increased escapes and decreased attractions