The Hospital Emigration to Another Region in the Light of the Environmental, Social and Governance Model in Italy During the Period 2004-2021

Resta, Emanuela and Resta, Onofrio and Costantiello, Alberto and Leogrande, Angelo (2023): The Hospital Emigration to Another Region in the Light of the Environmental, Social and Governance Model in Italy During the Period 2004-2021.

Abstract

The following article presents an analysis of the impact of the Environmental, Social and Governance-ESG determinants on Hospital Emigration to Another Region-HEAR in the Italian regions in the period 2004-2021. The data are analysed using Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS, Weighted Least Squares-WLS, and Dynamic Panel at 1 Stage. Results show that HEAR is negatively associated to E, positively to S and negatively associated to the G within the ESG model. The data were subjected to clustering with a k-Means algorithm optimized with the Silhouette coefficient. The optimal clustering with k=2 is compared to the sub-optimal cluster with k=3. The results suggest a negative relationship between the resident population and hospital emigration at regional level. Finally, a prediction is proposed with machine learning algorithms classified based on statistical performance. The results show that the Artificial Neural Network-ANN algorithm is the best predictor. The ANN predictions are critically analyzed in light of health economic policy directions.

• Item Type: MPRA Paper
• Language: English
• Keywords: Analysis of Health Care Markets, Health Behaviors, Health Insurance, Public and Private, Health and Inequality, Health and Economic Development, Government Policy, Regulation, Public Health.
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

[1] M. Frischhut e R. Levaggi, «Patient mobility in the context of austerity and an enlarged EU: the European Court of justice's ruling in the Petru case,» Health Policy, vol. 119, n. 10, pp. 1293-1297, 2015.

[2] N. Azzopardi-Muscat, R. Baeten, T. Clemens, T. Habicht, I. Keskimäki, I. Kowalska-Bobko e E. van Ginneken, «The role of the 2011 patients' rights in cross-border health care directive in shaping seven national health systems: Looking beyond patient mobility.,» Health Policy, vol. 122, n. 3, pp. 279-283., 2018.

[3] P. Carrera e N. Lunt, «A European perspective on medical tourism: the need for a knowledge base,» International Journal of Health Services , vol. 40, n. 3, pp. 469-484, 2010.

[4] G. Berki, «Cross-border patient mobility: the Legal Framework of obtaining healthcare abroad within the European Union: a patient’s perspective,» Doctoral dissertation Ghent University, 2015.

[5] D. A. Andritsos e C. S. Tang, «Introducing competition in healthcare services: The role of private care and increased patient mobility,» European Journal of Operational Research, vol. 234, n. 3, pp. 898-909, 2014.

[6] O. Kaufmann, «Legal Instruments and Cross-Border Patient Mobility,» in Unionsbürgerschaft und Patientenfreizügigkeit Citoyenneté Européenne et Libre Circulation des Patients EU Citizenship and Free Movement of Patients, 2014, pp. 25-30.

[7] S. L. Greer e S. Rauscher, «Destabilization rights and restabilization politics: policy and political reactions to European Union healthcare services law,» Journal of European Public Policy, vol. 18, n. 2, pp. 220-240, 2011.

[8] K. Veitch, «Juridification, medicalisation, and the impact of EU Law: Patient mobility and the allocation of scarce NHS resources,» Medical law review, vol. 20, n. 3, pp. 362-398, 2012.

[9] M. Krajewski, «Patient mobility beyond Calais: health services under WTO law,» Health Care and EU Law, pp. 453-478, 2011.

[10] D. Cantarero, «Health care and patients’ migration across Spanish regions,» The European Journal of Health Economics, vol. 7, pp. 114-116, 2006.

[11] I. Glinos, «Worrying about the wrong thing: patient mobility versus mobility of health care professionals,» Journal of Health Services Research & Policy, vol. 17, n. 4, pp. 254-256, 2012.

[12] A. Ricci, E. Barzan e F. Longo, «How to identify the drivers of patient inter-regional mobility in beveridgean systems? Critical review and assessment matrix for policy design & managerial interventions.,» Health Services Management Research, vol. 34, n. 4, 2021.

[13] S. A. N. Sayın e S. Delil, «Beyond a Health-Related Issues: Socioeconomic Determinants of Patient Mobility in Turkey,» Hacettepe Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, vol. 39, n. 1, pp. 121-131, 2021.

[14] K. G. Hem, B. Kalseth e A. Wilson, «Patient mobility in the Nordic Countries-Volume and obstacles,» Nordic Council of Ministers, 2011.

[15] G. Messina, S. Forni, F. Collini, C. Quercioli e N. Nante, «Patient mobility for cardiac problems: a risk-adjusted analysis in Italy,» BMC health services research, vol. 13, pp. 1-9, 2013.

[16] G. Messina, N. Vigiani, L. Lispi e N. & Nante, « Patient migration among the Italian regions in 2003.,» Italian Journal of Public Health, vol. 5, n. 1, 2008.

[17] G. Fattore, G. Petrarca e A. Torbica, «Traveling for care: Inter-regional mobility for aortic valve substitution in Italy,» Health Policy, vol. 117, n. 1, pp. 90-97, 2014.

[18] A. De Nicola, S. Gitto e P. Mancuso, «A two-stage DEA model to evaluate the efficiency of the Italian health system,» MPRA Paper, n. 68690, 2011.

[19] J. Ding, C. Yang, Y. Wang, P. Li, F. Wang, Y. Kang e L. Zhang, «Influential factors of intercity patient mobility and its network structure in China,» Cities, vol. 132, n. 103975, 2023.

[20] A. Aggarwal, D. Lewis, M. Mason, R. Sullivan e J. van der Meulen, «Patient mobility for elective secondary health care services in response to patient choice policies: a systematic review,» Medical Care Research and Review, vol. 74, n. 4, pp. 379-403, 2017.

[21] S. Balia, R. Brau e E. Marrocu, «Interregional patient mobility in a decentralized healthcare system,» Regional Studies, vol. 52, n. 3, pp. 388-402, 2018.

[22] M. J. Laugesen e A. Vargas-Bustamante, «A patient mobility framework that travels: European and United States–Mexican comparisons,» Health Policy, vol. 97, n. 2-3, pp. 225-231, 2010.

[23] M. Irlacher, D. Pennerstorfer, A. T. Renner e F. Unger, «Modeling inter-regional patient mobility: Does distance go far enough?,» 2021.

[24] A. Bjorvatn e A. Ma, «Patient mobility and public hospital waiting time. Four Essays on Health Care Reforms in Norway,» in PhD Dissertation. University of Bergen, 2011.

[25] I. A. Glinos, R. Baeten e H. Maarse, «Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries,» Health Policy, vol. 95, n. 2-3, pp. 103-112, 2010.

[26] T. Mainil, F. Van Loon, K. Dinnie, D. Botterill, V. Platenkamp e H. Meulemans, «Transnational health care: from a global terminology towards transnational health region development,» Health Policy, vol. 108, n. 1, pp. 37-44, 2012.