2023-12-06 12:26:59
by Chiara Daina
The National Agency for Regional Health Services (Agenas) has analyzed spending on interregional health mobility for the year 2022. The movements are mainly from South to North. Migration due to hospitalization is worth 3 billion a year
When you move from one region to another to be treated, the reasons are different.
Because we travel for health
They may depend on the patient’s free choice. Proximity healthcare mobility falls into these cases, i.e. when the citizen is better off turning to a facility across the border because it is closer to the place where he lives. Or, travel outside the region may be linked to the need to ensure adequate assistance. In this case, one can migrate because the services in the area are lacking, or require very long waiting times, but also to reach a reference center capable of providing high and very high complexity services for the treatment of rare or limited caseload (the concentration of patients in a limited number of selected centers serves to guarantee high clinical standards).
Bringing up the rear: Campania, Calabria and Sicily
The National Agency for Regional Health Services (Agenas) has analyzed spending on interregional health mobility for the year 2022.
That for hospital admissions amounts to almost 2.7 billion euros, up 9.6% compared to 2021, while still remaining lower than that of the pre-pandemic period (in 2019 it hit a record exceeding 2.8 billion EUR).
The three regions that attract the most patients are, in order: Lombardy (with an economic balance of 361 million euros between credits for active mobility, i.e. for the attraction of patients from other regions, and debts resulting from the flight of residents to other regions ), Emilia Romagna (with a balance of 337 million) and Veneto (with a balance of 107 million). While the main regions of escape are: Campania, Calabria and Sicily, which will have to reimburse 204 million euros, 178 million and 131 million respectively to the regions that provided hospitalization to their residents.
Appearing to move
Healthcare mobility also includes: apparent mobility, relating to services provided in the region in which the patient moved to live (for personal, work or study reasons), when this does not coincide with the region in which he resides; and the casual one, referring to the care that is received urgently in the holiday or work place, outside the borders of one’s own region. In more detail, in relation to extra-regional hospital admissions, Agenas highlights that the costs of apparent, casual and highly complex mobility last year remained almost unchanged compared to the pre-Covid era. In contrast, spending on hospitalizations for routine health problems of medium and low complexity fell by 18%.
Private structures accredited at the top
Accredited private structures dominate, in the sense that they are the ones that record the highest value of mobile hospitalizations (61% compared to 39% of the public). The movements are mainly from South to North. And to a lesser extent they concern proximity migration (calculated on a maximum distance of 50 km or 60 minutes from the patient’s municipality of residence to the border hospital), which accounts for 24% in the North, 12.6% in the Center and 5.7% in the South.
Lombardy improves waiting times
In 2022, Lombardy presents a decreasing balance compared to 2019 (from 488 million to 361) due to greater migration, especially at the border and for highly complex hospitalizations, but at the same time it improves the waiting times for its residents for surgical interventions scheduled with maximum priority in oncology (from 69.4% in 2019 to 85% in 2022) and in the musculoskeletal area (from 66% to 71%). Lazio has a lower negative balance (minus 24 million against minus 45 in 2029) because it has seen a decrease in escapes due to the high complexity of hospitalizations. That of Campania is also contracting (from minus 243 million to minus 204), Agenas points out, thanks to a greater ability to attract non-resident patients who require more complex hospital admissions.
Scopes
In general, the data on spending on mobility hospitalizations in the musculoskeletal field went from 596 million in 2019 to 672 in 2022. And spending in the oncology sector, despite the contraction in interventions due to the pandemic, reduced slightly (from 239 million at 223). Over the last five years, Agenas has detected a growing trend in spending on extra-regional outpatient specialists: from 609 million in 2019 to 635 million in 2022 and the value in the first half of 2023 (330 million) exceeded that recorded in the same period of the year last (325). Also in this case, Lombardy confirms itself in first place for attractiveness, followed by Veneto and Tuscany. Those, however, which see the greatest outflow of resident patients are once again: Campania, Calabria and Sicily. Proximity migration is strongest when it comes to carrying out visits and tests on an outpatient basis and corresponds to 33% of the total in the Northern regions, 20% in those of the Center and 12% in those of the South. Healthcare mobility is certainly a test bed that measures the ability of the Regions to respond to internal health demand.
In some cases, interregional travel must be encouraged
But migration is not always a demerit factor. Indeed, in some cases interregional travel should be encouraged. Mobility towards centers of excellence that treat rare and complex pathologies, such as some types of cancer, and which concentrate volumes of activity and skills such as to ensure patient services in accordance with quality and safety standards – comments Maria Pia Randazzo, head of the Agenas’ operational unit for statistics and health information flows. On the contrary, long journeys for the treatment of minor pathologies which should find appropriate assistance in the area should be discouraged. I am referring in particular to osteoarticular ones, such as knee prostheses and hallux valgus. It is essential to continue promoting the culture of clinical networks at a regional level to ensure widespread care across the territory. The network model includes specialized centers for the management of more complex cases, which include peripheral centers that act as access points to the network close to home. For example, thanks to the development of breast units throughout Italy, the networks for the diagnosis and treatment of breast cancer, the migration of women with breast cancer has decreased.
The satisfaction
Angenas has developed a new indicator on the satisfaction of internal demand, to evaluate the ability of healthcare facilities to respond to the health needs of their residents. The best performing regions are led by Emilia Romagna, which produces more than what is required. The same goes for Lombardy, placing second, Veneto, third, and Tuscany, fourth. Production volumes sufficient to cover internal demand are found in Lazio, the Provinces of Trento and Bolzano, Friuli Venezia Giulia, Piedmont and Molise. The rest of the Regions, however, do not satisfy requests for assistance. This indicator can be compared with the bed utilization rate to verify whether regional health services can perform better, increasing care capacity.
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December 6, 2023 (modified December 6, 2023 | 11:26)
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