Health spending, income inequality and patient mobility: Evidence from Italian regions

This study investigates the interplay between income inequality, health spending and patient mobility within the context of the Italian healthcare system. By analysing a balanced panel of 15 Italian regions from 2003 to 2019, we examine how income inequality influences regional health expenditure policies and moderates the relationship between interregional compensation for patient mobility and public health spending. Our findings indicate that both income inequality and patient mobility shape regional health spending decisions. Specifically, the analysis reveals that higher income inequality tends to be associated with greater health expenditure, whereas credits from interregional health mobility exhibit a positive association with spending, albeit with varying intensity based on the level of regional income inequality. Importantly, our analysis reveals that the effectiveness of mobility-based credits in supporting healthcare spending weakens in regions with high income inequality, suggesting that regional disparities can limit the financial benefits of patient mobility inflows. These results underscore the potential risks of further decentralizing healthcare governance in Italy, in the light of the complex interplay between patient mobility, health spending and income inequality at regional level, highlighting the need for targeted policies to mitigate the negative externalities of patient migration and promote equitable healthcare provision across regions.