ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1551574
Is cooperation better than competition? Evidence from patient mobility before and after the COVID-19 pandemic in Tuscany, Italy
Provisionally accepted
- 1Post Graduate School of Public Health, University of Siena, Siena, Tuscany, Italy
- 2Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Sicily, Italy
- 3Healthcare Management, University Hospital Trust of Ferrara, Ferrara, Italy
- 4Department of Molecular Medicine and Development, University of Siena, Siena, Tuscany, Italy
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Introduction: According to Italian Law, citizens have the right to choose the preferred place of care; in this context, the competition between various hospitals across the national territory is inevitable. The study aims to analyze the associations between patient mobility between Tuscany (Italy) and other Italian regions and the of weight of Diagnosis Related Groups (DRGs) provided for these hospitalizations, as a proxy of complexity of care provided.Methods: A retrospective study was conducted using 2019 and 2022 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patient attractions and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using Odds Ratios (OR). The analysis was performed thought STATA software, and the significance level was set at 95%.In studied period, for Digestive Diseases (in 2019 OR: 1.37; 95%CI: 1.08-1.74; in 2022 OR: 1.66; 95%CI: 1.29-2.12), patients from non-border regions were more likely to be attracted to the Tuscany hospitals for HS DRGs, while for Musculoskeletal Diseases (in 2019 OR: 0.51; 95%CI: 0.47-0.56; in 2022 OR: 0.53; 95%CI: 0.48-0.59), those from non-border regions were less likely to be attracted for HS DRGs (p<0.05). For the same years, for Nervous Diseases (
Keywords: Hospital patient mobility, Health Policy, Italian National Health Service, Regional strategies, Cross-Border Mobility, DRGs
Received: 25 Dec 2024; Accepted: 10 Jul 2025.
Copyright: © 2025 Guarducci, Golinelli, Spadea, Fabbri and Nante. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Giovanni Guarducci, Post Graduate School of Public Health, University of Siena, Siena, Tuscany, Italy
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