Study edited by L. Grazzini, P. Lattarulo, M. Macchi
Regional health and mobility demand
This activity is carried out as part of the collaboration with the Tuscany Region and the Cohesion Agency CPT Evaluation Unit. The study was conducted by Lisa Grazzini (University of Florence), Patrizia Lattarulo (IRPET), Marika Macchi (University of Florence). The authors wish to thank Dr. Silvano Castangia (Region of Sardinia), for his valuable advice on the first draft of the work. The pandemic event has called into question not only the health organization at national level but, above all, the response capacity and organizational models of the individual Regions. The National Recovery and Resilience Plan (henceforth PNRR), which today represents the main instrument of the health system development policy, has highlighted not only the need to increase the infrastructural endowment of the regions with the most deficits, but also the need to fill territorial imbalances with particular attention to proximity medicine. This can be read in the investments destined for healthcare homes, telemedicine and the strengthening of continuity of care. These territorial inequalities between regions and, as we shall see, sometimes even between provinces or vast areas, in addition to undermining the principle of equity, contribute to the creation of healthcare mobility, i.e. the activation of migratory flows which lead the population to choose a path of care in regions other than those of residence. As defined by Agenas and Gimbe, the two main institutes that observe the phenomenon of healthcare mobility, the phenomenon is growing and continues to strengthen areas with positive balances of attraction and to increase the exodus from regions with high outgoing mobility. The Agenas Report (2021) highlighted this trend in the decade 2008-2018, highlighting how the Regions in the recovery plan had a higher emigration rate than the regions of northern Italy which recorded very high active mobility rates.
Clearly, the reasons that can drive citizens to seek treatment in contexts other than the one in which they reside can be many: a high level of income, propensity to move, the level of education, proximity to the family support system, the choice for reputation of a hospital system, the type of care needed and the frequency of care, the patient’s age and gender (Fotaki et al., 2008; Williams and Rossiter, 2004; Popper et al., 2006). This type of motivation, linked to subjective preferences, is what is guaranteed by the principle of freedom of choice that the national health service derives directly from the constitutional provisions (art. 32), and that we will deal with in its organizational aspects in the second paragraph in relation to the balance between a universal system that guarantees healthcare assistance to every citizen and a regionalized system. However, wanting to focus our attention on the strong imbalances that are polarizing the less attractive regions and those with prevailing active mobility, which will be briefly described in the third paragraph, it is important to emphasize the determining factors in population movements deriving from the structuring of the offer. In particular, there are two factors that push towards forces of concentration: the first is the one that pushes to aggregate skills and resources towards the treatment of diseases that have significant economies of scale and specialization; the second is congenital in the under-equipment (infrastructural, organizational and organic) of the healthcare offer of some regions. (…)
