Are hospital beds endowment a driver of patients’ migration?

Background and Objective: In a decentralized healthcare system like the Italian, where regions are in a potentially competitive regime since citizens are free to choose their place of treatment, healthcare migration is particularly relevant. The study aims to analyze the fulfilment of the need for hospital rehabilitation services on site and to assess whether bed endowment is a driver of patients’ migration. Methods: From 2011 to 2019, admission data for rehabilitation were collected from the Hospital Discharge Cards database of the Italian Ministry of Health (IMH). For the same period, data of bed endowment were collected from the website of IMH and population data from the Italian National Institute of Statistics website to calculate the number of beds (NB) x 1,000 inhabitants. For each region, data on Residents, Attractions and Escapes were developed through Gandys Nomogram and summarised through Attraction (AI) and Escape (EI) Indexes. NB x 1,000 inhabitants were correlated with AI and EI through Spearman’s test. Results: Gandy’s Nomogram showed that only Piedmont, Lombardy, A.P. of Trento, Veneto had good hospital planning for rehabilitation. A statistically significant correlation (p<0.05), between AI and NB x 1,000 inhabitants was found for Veneto (rho= 0.7000), Latium (rho= 0,7333), Molise (rho= -0.8667) and Basilicata (rho= 0.8500), while between EI and NB x 1,000 inhabitants were found for A.P. of Bolzano (rho= -0.667), E.Romagna (rho= -0.7000), Umbria (rho= -0.6667), Latium (rho= -0.8333), Molise (rho= -0.7333), Basilicata (rho= 0.7667), Calabria (rho= -0.7776) and Sicily (rho= -0.9500). Conclusion: Only four regions appear able to satisfy the care needs of their Residents, with an Attractions minus Escapes positive balance. The beds’ endowment seems to be a driver of Patients’ migration, mainly for escapes. Indeed, the research of Patients’ migration drivers needs further investigation, given the paradoxical situation that appeared in Molise and Basilicata.