title: Patient mobility and health care quality when regions and patients differ in income.
abstract: We study the effects of cross-border patient mobility on health care quality and welfare when income varies across and within regions. We use a Salop model with a high-, middle-, and low-income region. In each region, a policy maker chooses health care quality to maximise the utility of its residents when health care costs are financed by general income taxation. In equilibrium, regions with higher income offer better quality, which creates an incentive for patient mobility from lower- to higher-income regions. Assuming a prospective payment scheme based on DRG-pricing, we find that lower non-monetary (administrative) mobility costs have (i) no effect on quality or welfare in the high-income region; (ii) a negative effect on quality but a positive effect on welfare for the middle-income region; and (iii) ambiguous effects on quality and welfare for the low-income region. Lower monetary mobility costs (copayments) might reduce welfare in both the middle- and low-income region. Thus, health policies that stimulate cross-border patient mobility can be counterproductive when regions differ in income.
authors.affiliation: Department of Economics, Norwegian School of Economics, Helleveien 30, N-5045 Bergen, Norway. Electronic address: kurt.brekke@nhh.no.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Brekke
authors.affiliation: Department of Economics and Management, University of Brescia, Via San Faustino 74b, 25100 Brescia, Italy. Electronic address: rosella.levaggi@unibs.it.
authors.forename: Rosella
authors.initials: R
authors.lastname: Levaggi
authors.affiliation: Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK. Electronic address: luigi.siciliani@york.ac.uk.
authors.forename: Luigi
authors.initials: L
authors.lastname: Siciliani
authors.affiliation: Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Department of Economics, University of Bergen, Norway. Electronic address: o.r.straume@eeg.uminho.pt.
authors.forename: Odd Rune
authors.initials: OR
authors.lastname: Straume
mesh_terms: D005062:European Union; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007182:Income; D011787:Quality of Health Care; D012946:Social Welfare; D019966:Substance-Related Disorders; D014195:Travel
keywords: Health care quality; Income inequalities; Patient mobility; Regional welfare; Salop model