Social capital and patients’ mobility in Italy

ABSTRACT

Using a 10-year (2006–15) regional dataset on hospital discharges, we estimate the determinants of Italian regional outflow rates while also including three proxies for social capital: the quality of friendships, the involvement in social activities and the ratio of blood donors to the population. We find a significant push effect from the lack of social capital intended as generalized expectation of cooperative behaviour (proxied by blood donors); this does not hold true for the other two proxies of social capital. The lack of a cultural context where norms of reciprocity matter may reduce regions’ ability to retain their patients.

KEYWORDS:

• interregional patient mobility
• social capital
• decentralized health systems
• panel model
• spatial spillovers

JEL:

• C23
• I10
• Z13

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors.

Notes

1. We thank an anonymous referee for the suggestion of this possible effect.

2. We will define these variables in the following section.

3. We test for robustness using different distance bands and W matrices based on contiguity.

4. We tried to obtain data distinguishing patient mobility from emergencies for the period 2006–15 from the Health Ministry SDO, but were unsuccessful. We obtained the data only relative to 2015. Other published works on Italian patients’ regional mobility (e.g., Brenna & Spandonaro, 2015) using SDO data do not discharge emergencies.

5. The island of Sardinia is considered not to have any bordering region. Sicily is assumed to border Calabria (the time distance to travel by car from Messina to Reggio Calabria is about 50 min).

6. Agenas data are available only from 2010.

7. In 2017, the Ministry of Health published for the first time the report Rapporto sulla rilevazione delle apparecchiature sanitarie in Italia, aimed at monitoring Italian regions’ health equipment. The report contains interesting data on high-technologies such as magnetic resonance imaging (MRI) with respect to the intensity of resolution (Ministry of Health, 2017). This helps us in describing the degree of innovation of regional technological endowment.

8. Mazziotta and Pareto (2011) calculate a more complex technology endowment index for 2005 showing means of 98.6 in the Centre-North and 100.9 in the South.

9. Results are available from the authors upon request.

10. Results are available from the authors upon request.