Economics & Sociology

ISSN: 2071-789X eISSN: 2306-3459 DOI: 10.14254/2071-789X
Index PUBMS: f5512f57-a601-11e7-8f0e-080027f4daa0
Article information
Title: Patient Cross-Border Mobility: New Findings and Implications in Spanish Regions
Issue: Vol. 10, No 1, 2017
Published date: 03-2017 (print) / 03-2017 (online)
Journal: Economics & Sociology
ISSN: 2071-789X, eISSN: 2306-3459
Authors: Carla Blázquez-Fernández
University of Cantabria

David Cantarero-Prieto
University of Cantabria

Marta Pascual-Sáez
University of Cantabria
Keywords: health care, patient migration, panel data, Spain
DOI: 10.14254/2071-789X.2017/10-1/1
Index PUBMS: 5f7b463c-003d-11e8-94c4-fa163e5d4f72
Language: English
Pages: 11-21 (11)
JEL classification: I10, I18

Spain has a National Health Service with a mixed public-private funded system. In the last decades, a huge effort has gone into reducing barriers to patient migration. We estimate a panel data based on a gravity model of migration since the process of health care decentralization has been completed in Spain. Our empirical results show that income is one of the most important drivers in explaining mobility as well as supply variables. Individual characteristics are not among the main factors for mobility. Besides, it is demonstrated there is a quality-driven mobility in Spain. However, there was no significant difference in the influence on patients’ mobility between those living in the North of the country and the Mediterranean regions. The empirical results also suggest that current regional health policies in Spain, that explain patients’ mobility, should be associated with greater funding system.


1. Arltová, M., Smrcka, L., Vrabcová, J. and Schönfeld, J. (2016), The ageing of the population in developed countries-the economic consequences in the Czech Republic, Economics & Sociology, Vol. 9, No. 2, p. 197.

2. Arrow, K. J. (1963), Uncertainty and the welfare economics of medical care, American Economic Review, Vol. 53, No. 5, pp. 941-973.

3. Baker, L. C, Bundorf, M. K, Kessler, D. P. (2014), Patient’s preferences explain a small but significant share of regional variation in medical spending, Health Affairs, Vol. 27, No. 2, W123-134.

4. Balia, S., Brau, R., Marrocu, E. (2014), Free patient mobility is not a free lunch. Lessons from a decentralised NHS, Centre for North South Economic Research, No. 201409, University of Cagliari and Sassari, Sardinia.

5. Brekke, K. R., Levaggi, R., Siciliani, L., Straume, O. R. (2015), Patient mobility and health care quality when regions and patients differ in income, Journal of Economic Behaviour and Organization, Vol. 105, pp. 140-157.

6. Brenna, E., Spandonaro, F. (2015), Regional incentives & patient cross-border mobility: evidence from the Italian experience, International Journal of Health Policy and Management, Vol. 4, No. 6, pp. 363-372.

7. Cantarero, D. (2006), Health care and patients’ migration across Spanish regions, European Journal of health Economics, Vol. 7, No. 2, pp. 114-116.

8. Centre for Market and Public Organisation (CMPO) (2007), Hospital care in England: who will choose? Research in Public Policy, University of Bristol, http://www.bristol.

9. Congdon, P. (2001), The development of gravity models for hospital patient flows under system change: A bayesian modelling approach, Health Care Management Science, Vol. 4, pp. 289-304.

10. Costa-Font, J. (2010), Does devolution lead to regional inequalities in welfare activity? Environment and planning. C, Government and Policy, Vol. 28, No. 3, pp. 435-449.

11. Cuenca, A., González, R. (2015), Sistema de financiación autonómica y gasto sanitario en España, Papeles de Economía Española, Vol. 143, pp. 75-93.

12. De Mello-Sampayo, F. (2014), Gravity for health: An application to state mental hospital admissions in Texas, MPRA Paper, No. 59758.

13. Exworthy, M., Peckham, S. (2006), Access, choice and travel: implication for health policy, Social Policy and Administration, Vol. 40, pp. 267-87.

14. Fabbri, D., Robone, S. (2010), The geography of hospital admission in a National Health Service with patient choice, Health Economics, Vol. 19, pp. 1029-1047.

15. Finkelstein, A., Gentzkow, M., & Williams, H. (2016), Sources of geographic variation in health care: Evidence from patient migration, The Quarterly Journal of Economics, Vol. 131(4), pp. 1681-1726.

16. Frischhut, M., Levaggi, R. (2015), Patient mobility in the context of austerity and an enlarged EU: The European Court of Justice´s ruling in the Petru Case, Health Policy, Vol. 119, pp. 1293-1297.

17. Glinos, I. A, Baeten, R., Helbe, M., Maarse, H. (2010), A typology of cross border mobility, Health and Place, Vol. 16, pp. 1145-55.

18. Glinos, I., Doering, N., Maarse, H. (2012), Travelling home for treatment and EU patients’ right to care abroad: results of a survey among German students at Mastricht University, Health Policy, Vol. 105, pp. 38-45.

19. González López-Valcárcel, B., Barber, P. (2017), Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain, Applied Health Economics and Health Policy, Vol. 15(1), pp. 13-21.

20. Grossman, M. (1972a), The demand for health: a theoretical and empirical investigation, New York; National Bureau of Economic Research, Columbia University Press.

21. Grossman, M. (1972b), On the concept of health capital and the demand for health, Journal of Political economy, Vol. 80, No. 2, pp. 223-255.

22. Levaggi, R., Zanola, R. (2004), Patients’ migration across regions: the case of Italy, Applied Economics, Vol. 36, No. 16, pp. 1751-1757.

23. Lopez-Casasnovas, G., Costa-Font, J., Planas, I. (2005), Diversity and regional inequalities in the Spanish system of health care services, Health Economics, Vol. 14, no. 1, S221-35.

24. Lowe, J. M., Sen, A. (1996), Gravity model application in health planning: analyses of an urban hospital market, Journal of Regional Sciences, Vol. 36, pp. 437-461.

25. Luboga, S., Hagopian, A., Ndiku, J., Bancroft, E., McQuide, P. (2011), Satisfaction, motivation, and intent to stay among Ugandan physicians: a survey from 18 national hospitals, International Journal of Health Policy and Management, Vol. 26, No. 1, pp. 2

26. Lunt, N., Mannion, R., Exworthy, M. (2013), A framework for exploring the policy implication of UK Medical Tourism and international patient flows, Social Policy and Administration, Vol. 47, pp. 1-25.

27. Lunt, N., Mannion, R. (2014), Patient mobility in the global marketplace: a multidisciplinary perspective, International Journal of Health Policy and Management, Vol. 14, No. 2, pp. 155-7.

28. Marchal, B., Kegels, G. (2003), Health workforce imbalances in times of globalization: brain drain or professional mobility? International Journal of Health Policy and Management, Vol. 18, S1, S89-S101.

29. Migge, B., Gilmartin, M. (2011), Migrants and healthcare: investigating patient mobility among migrants in Ireland, Health and Place, Vol. 17, pp. 1144-1149.

30. Oates, W. E. (2005), Toward a second-generation theory of fiscal federalism, International Tax and Public Finance, Vol. 12, pp. 349-373.

31. Rivera, B. (2004), Evidence on the relationship between public medical resources and health indicators, Journal of Economic Studies, Vol. 31, No. 2, pp. 98-111.

32. Roghman, K. J. and Zastowny, T. R. (1979), Proximity as a factor in the selection of health care providers: emergency room visits compared to obstetric admissions and abortions, Social Science and Medicine, Vol. 13, pp. 61-69.

33. Tiebout, C. (1956), A pure theory of local expenditures, The Journal of Political Economy, Vol. 64, pp. 416-24.

34. Urbanos-Garrido, R. M., Lopez-Valcarcel, B. G. (2015), The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain, The European Journal of Health Economics, Vol. 16, No. 2, pp.175-184.

35. Weingast, B. R. (2009), Second generation fiscal federalism: The implications of fiscal incentives, Journal of Urban Economics, Vol. 65, pp. 279-293.

36. World Bank (2009), Averting a human crisis during the global downturn, Washington.