A first step to investigate European patients’mobility: the interregional Italian experience

Background The study of patients’ mobility, identifying deficiencies and imbalances in care supply, is useful for the health planning. The topic is of great relevance in the international arena, given the Directive 2011/24/EU on cross-border healthcare, which promotes the free movement of patients between Member States of the European Community. The Italian Health System, consisting of 21 different regional realities with characteristics, can be taken as a microcosmic test bench, somehow predictive of possible European dynamics. Our study aims to: 1) describe the trend of hospital patients’ mobility among the Italian Regions over a wide time span, 2) show an immediate visual approach for decision making. Methods We used ordinary and day hospital discharge data (HDR) from 1998 to 2011. The study was carried out using: 1) the Gandy’s Nomogram (NdG), a graphical tool that allows assessing the power of attraction and the escape’s containment of hospital regional networks; 2) vector analysis; 3)trend analysis with Cuzik’s test. Results The mean number of annual admissions (1998-2011), in Italian hospitals, was 11.424.319 decreasing from 2001 to 2011, 7% occurred ‘in mobility’. We have drawn the different paths of patients’ mobility by Regions and observed some critical situations, almost in Regions of Southern and Island Italy, compared with Regions of the Centre-North which overall appeared in better condition. Some Regions showed a biphasic trend, having the year of reversal around 2006. Conclusions We have shown the potentialities of a useful tool of assessment, the NdG, applicable at micro level but also on a large scale (as the European scenario), in the analysis of hospital patients’ mobility. It can be hypothesized that the reversal of patients’ mobility trends occurred in some Regions might be related to a government program aimed at restoring the financial balance, on penalty of compulsory administration. The observation of the trend of each Region provides information about policies adopted by hospitals and possible corrective actions. Key messages Our study shows the usefulness of an immediate visual approach (Gandy’s Nomogram) to the analysis of hospital patients’ flows at different levels (micro, meso and macro). Italian inter-regional patients’ mobility trends (predictive of the possible European scenario induced by the EU Directive on cross-border migration) provide objective information for health policy.