title: Regional incentives and patient cross-border mobility: evidence from the Italian experience.
abstract: BACKGROUND
  In recent years, accreditation of private hospitals followed by decentralisation of the Italian National Health Service (NHS) into 21 regional health systems has provided a good empirical ground for investigating the Tiebout principle of "voting with their feet". We examine the infra-regional trade-off between greater patient choice (due to an increase in hospital services supply) and financial equilibrium, and we relate it to the significant phenomenon of Cross-Border Mobility (CBM) between Italian regions. Focusing on the rules supervising the financial agreements between regional authorities and providers of hospital care, we find incentives for private accredited providers in attracting patient inflows.
  
  
  METHODS
  The analysis is undertaken from an institutional, regulatory and empirical perspective. We select a sample of five regions with higher positive CBM balance and we examine regional regulations governing the contractual agreements between purchasers and providers of hospital care. According to this sample, we provide a statistical analysis of CBM and apply a Regional Attraction Ability Index (RAAI), aimed at testing patient preferences for private/public accredited providers.
  
  
  RESULTS
  We find that this index is systematically higher for private providers, both in the case of distance/boundary patients and of excellence/general hospitals.
  
  
  CONCLUSIONS
  Conclusions address both financial issues regarding the coverage of regional healthcare systems and equity issues on patient healthcare access. They also raise concerns on the new European Union (EU) directive inherent to patient mobility across Europe.
authors.affiliation: Department of Economics and Finance, Università Cattolica del S. Cuore, Milano, Italy.
authors.forename: Elenka
authors.initials: E
authors.lastname: Brenna
authors.affiliation: Department of Economics, Law and Institutions, Università Tor Vergata, Roma, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Spandonaro
mesh_terms: D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009313:National Health Programs / Q000458:organization & administration*; D017149:Private Sector / Q000706:statistics & numerical data*
keywords: Hospitals’ Accreditation; Italian National Health Service (NHS); Patient Choice; Patient Mobility; Regional Strategies