"I pay with my feet": The hidden power of freedom of choice in regulated healthcare systems

This paper proposes a relational perspective for analyzing patient mobility flows among Italian regions and exploring how regional resource endowment and its utilization explain mobility patterns. The data used refer to patient mobility for private medical services in the Italian NHS in the year 2014. We compute network centrality indicators to describe the tendency of certain regions to be recipients or senders in patient mobility patterns. A logistic regression quadratic assignment procedure is also used to study, at the dyadic level, the relation between regional structural characteristics and resource endowment and the probability of observing patient mobility flows across regions. Our findings document that differences in the level of resource endowments among pairs of regions are positively associated with the likelihood of observing patient mobility flows. Notably, we found that higher differences in the number of staffed physicians and in the productivity with which regions deliver medical services are positively associated with the probability of observing inter-regional patient mobility. Moreover, more productive regions are more likely to receive patients from other regions. Finally, our results show that patient mobility flows are less likely to occur across regions that are far apart. Overall, these findings provide important implications for policy makers.