Patient flight to other regions exceeds 5 billion: Lombardy, Emilia and Veneto the most popular

The flow of citizens going for treatment outside their region of residence has never been so massive. In 2023, inter-regional healthcare mobility - what used to be called patients' journeys of hope - reached a record 5.15 billion, the highest level ever, an increase of 2.3% compared to 2022 when it was 5.04 billion. People move mainly from the South to the North - with hospitals in Lombardy, Emilia and Veneto among the most popular -, but increasingly there are also strong shifts between northern regions. These are the trends outlined in the new report on healthcare mobility by the Gimbe Foundation presented on the occasion of its thirtieth anniversary, from which it also emerges that the growth in healthcare mobility in Italia is mainly favouring private healthcare facilities. "These numbers," says Gimbe president Nino Cartabellotta, "indicate that healthcare mobility is less and less a choice and more and more a necessity. When billions of euro and hundreds of thousands of patients converge towards a few regions, it means that the supply of services is not homogeneous and that the right to health protection is not guaranteed equally throughout the country".

Lombardy, Emilia-Romagna and Veneto account for 95.1% of the positive balance of health mobility, i.e. the difference between resources received to treat patients from other regions and those paid for their own residents treated elsewhere. On the opposite side, those paying the highest price are Calabria, Campania, Puglia, Sicily, Lazio and Sardinia, which together absorb 78.2% of the debit balance. "We are no longer facing simple regional differences," warns Gimbe's president, "but a structural gap that has consolidated over time. In this scenario, differentiated autonomy, with the go-ahead for the pre-agreements for Liguria, Lombardy, Piedmont and Veneto, will inevitably widen inequalities'. In particular, active mobility - that is, the attraction of patients 'fleeing' from other regions - is concentrated for more than half in Lombardy (23.2%), Emilia-Romagna (17.6%) and Veneto (11.1%), followed by Latium (8.9%), Tuscany (6.4%) and Piedmont (5.8%) . On the opposite front, the largest outlays for treatment received by their own residents in other regions are borne by Lazio (12.1%), where, however, the presence of 'extra-territorial' facilities such as the Bambino Gesù, which is a Vatican facility, Campania (9.4%) and Lombardy (9.2%), which alone account for almost a third of the total, with over 400 million each. 'Passive mobility,' Cartabellotta explains, 'does not coincide exclusively with the flight of patients from South to North. There is also a proximity mobility between neighbouring northern regions with high quality services. Regions such as Lombardy, Veneto and Piedmont register significant levels of passive mobility'.

The growth of healthcare mobility in Italia is then mainly favouring private healthcare facilities. For every euro spent to pay for specialist services provided outside the Region, more than half is collected by private contracted healthcare, to which, in 2023, 1,966 million went compared to the 1,643 million of public facilities, warns the Gimbe Foundation's Healthcare Mobility Report. "The share of mobility flowing to the private contracted sector is not homogeneous in all regions," Cartabellotta explains. "It depends on the offer and the attractiveness of private facilities of excellence." Thus the report shows how in Molise the private sector attracts 90.2% of active mobility, in Lombardy 71.1%, in Apulia 68.9%, in Lazio 63.8%. At the other extreme are Basilicata, where the private sector attracts only 7.2% of active mobility, the Autonomous Province of Bolzano (9.1%), Liguria (11.4%), Umbria (15.1%) and Valle D'Aosta (15.7%). The analysis also shows what patients who go outside the Region are looking for. Among the admissions, about half (52.4%) are related to high complexity operations, while 41.1% are related to medium or low complexity operations. A further 6.5% of patients travel, then, for operations classified as at risk of inappropriateness.

The report also confirms that only a minority of treatments obtained outside the Region are linked to immediate needs (e.g. an emergency while outside the Region) or to the fact that the patient's home does not coincide with the Region of residence, as in cases where the hospital closest to home is not in one's own Region. According to Agenas data, 80.4% of mobility for admissions is classified as actual for 2.311 billion, i.e. it depends on the patient's choice. On the other hand, 16.7% (€ 480 million) is related to urgent services (random mobility) and 3% (€ 85 million) concerns cases in which the patient's domicile does not coincide with the Region of residence (apparent mobility). Of the actual mobility, only 6.5% concerns ordinary admissions at risk of inappropriateness, that is, truly unnecessary. Of the specialist outpatient services provided in mobility, almost 93 per cent are concentrated in three categories: therapeutic services (33.1 per cent), instrumental diagnostics (31.5 per cent) and laboratory services (28 per cent). "GIMBE's thirtieth anniversary," Cartabellotta concludes, "marks the beginning of a new chapter for the Foundation: the start of community involvement, with instruments dedicated to structurally strengthening independent research, health education, the conscious use of public health, and political-institutional advocacy aimed at relaunching the SSN".