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The analysis of a cardiological network in a regulated setting: a spatial interaction approach

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  • Matteo Lippi Bruni
  • Lucia Nobilio
  • Cristina Ugolini

Abstract

We analyse referral patterns for patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in the Emilia Romagna region of Italy, a procedure for which the assumption of a negative association between volume and adverse outcomes is used to justify its territorial concentration. Nevertheless, recent clinical evidence shows PTCA superiority for immediate treatment of acute myocardial infarction, which advises an increase in the number of points of delivery. Our paper aims to develop analytical tools designed to provide support to policy makers when they are asked to evaluate the spatial distribution of catheterisation laboratories that perform PTCA. Information is drawn from the regional administrative hospital discharge data (SDO) for the year 2002. We first use entropy indexes to investigate the spatial accessibility of the cardiological network. Secondly, by means of a gravity model estimated using Bayesian techniques we identify the determinants of patient flows in terms of demand and supply factors. Our results suggest that information on destinations is processed hierarchically and that agglomeration‐like forces are dominant. Furthermore, although self‐sufficiency of provision at the provincial level has been achieved to a large extent, there is still scope to improve the organisational efficiency of the network. Copyright © 2007 John Wiley & Sons, Ltd.

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  • Matteo Lippi Bruni & Lucia Nobilio & Cristina Ugolini, 2008. "The analysis of a cardiological network in a regulated setting: a spatial interaction approach," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 221-233, February.
    • Handle: RePEc:wly:hlthec:v:17:y:2008:i:2:p:221-233
    DOI: 10.1002/hec.1255
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    2. Paolo Berta & Gianmaria Martini & Daniele Spinelli & Giorgio Vittadini, 2022. "The beaten paths effect on patient inter‐regional mobility: An application to the Italian NHS," Papers in Regional Science, Wiley Blackwell, vol. 101(4), pages 945-977, August.
    3. Anna-Theresa Renner & Dieter Pennerstorfer, 2020. "Modeling inter-regional patient mobility: Does distance go far enough?," Economics working papers 2020-04, Department of Economics, Johannes Kepler University Linz, Austria.
    4. Claudio Pinto, 2017. "Perceived quality and formation of inter-regional networks of health care migration," Advances in Management and Applied Economics, SCIENPRESS Ltd, vol. 7(3), pages 1-5.
    5. Felipa De Mello-Sampayo, 2016. "A Spatial Analysis of Mental Healthcare in Texas," Spatial Economic Analysis, Taylor & Francis Journals, vol. 11(2), pages 152-175, June.
    6. Fattore, Giovanni & Petrarca, Giuseppina & Torbica, Aleksandra, 2014. "Traveling for care: Inter-regional mobility for aortic valve substitution in Italy," Health Policy, Elsevier, vol. 117(1), pages 90-97.
    7. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 63-77, September.
    8. S. Balia & Rinaldo Brau & E. Marrocu, 2014. "Free patient mobility is not a free lunch. Lessons from a decentralised NHS," Working Paper CRENoS 201409, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    9. Luciano de Andrade & Vanessa Zanini & Adelia Portero Batilana & Elias Cesar Araujo de Carvalho & Ricardo Pietrobon & Oscar Kenji Nihei & Maria Dalva de Barros Carvalho, 2013. "Regional Disparities in Mortality after Ischemic Heart Disease in a Brazilian State from 2006 to 2010," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-10, March.
    10. Michael Irlacher & Dieter Pennerstorfer & Anna‐Theresa Renner & Florian Unger, 2023. "Modeling Interregional Patient Mobility: Theory And Evidence From Spatially Explicit Data," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 64(4), pages 1493-1532, November.
    11. Emanuela Marrocu & Silvia Balia & Rinaldo Brau, 2016. "A spatial analysis of inter-regional patient mobility in Italy," ERSA conference papers ersa16p127, European Regional Science Association.

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