Exploring Determinants of inter-regional Patient Mobility

Background

In the Italian National Healthcare System, where patients are free to choose their place of care, analysing inter-regional patient mobility is particularly relevant. This study examines its determinants.

Methods

A retrospective study was conducted on 2022 surgical DRG data from Hospital Discharge Cards. Factors associated with hospitalization outside vs within the region were analysed using logistic regression in Stata. Independent variables were age group (reference: 45-64 years), sex, highly specialized (HS) vs non-HS DRGs, and hospital type (reference: Directly Managed Hospitals). The significance level was set at 0.05.

Results

Compared with those aged 45-64 years, patients aged 1-4 years were more likely to be hospitalized outside their region (OR 3.36, 95%CI 3.17-3.57), whereas all other age groups were less likely: infants aged <1 year by 1% (OR 0.99, 95%CI 0.98-0.99), children aged 5-13 years by 25% (OR 0.75, 95%CI 0.72-0.81), those aged 14 years by 73% (OR 0.27, 95%CI 0.26-0.28), those aged 15-24 years by 65% (OR 0.35, 95%CI 0.31-0.37), those aged 25-44 years by 54% (OR 0.46, 95%CI 0.42-0.47), those aged 65-74 years by 69% (OR 0.31, 95%CI 0.31-0.32), and those aged ≥75 years by 71% (OR 0.29, 95%CI 0.28-0.30). Males were 40% less likely than females to be hospitalized outside their region (OR 0.60, 95%CI 0.59-0.61). HS DRGs were 73% more likely than non-HS DRGs to involve out-of-region hospitalization (OR 1.73, 95%CI 1.72-1.75). Compared with Directly Managed Hospitals, admissions to Research Institutes and Teaching Hospitals were 28% and 23% more likely, respectively, to occur outside the region (OR 1.28, 95%CI 1.22-1.29; OR 1.23, 95%CI 1.22-1.24), whereas admissions to Private Clinics were 12% less likely (OR 0.88, 95%CI 0.87-0.90). All associations were statistically significant (p < 0.001).

Conclusions

These mobility patterns highlight gaps in healthcare delivery that require targeted policy interventions to ensure equitable access to care.

Key messages

• Inter-regional patient mobility in Italy is strongly influenced by age, gender, specialization of care, and hospital type, indicating structural disparities in healthcare accessibility.

• Targeted policies are needed to reduce healthcare inequalities and ensure equitable access, particularly for young children and patients requiring highly specialized services.