Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings

Health care systems rely on geographical boundaries that secure financial stability and adequate planning. Quality differences across regions often arise for efficiency reasons, causing patient flows if mobility is free. In this paper, a theoretical spatial competition model is developed to study th...

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Main Authors: Laura Levaggi, Rosella Levaggi
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Games
Subjects:
Online Access:https://www.mdpi.com/2073-4336/16/3/31
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author Laura Levaggi
Rosella Levaggi
author_facet Laura Levaggi
Rosella Levaggi
author_sort Laura Levaggi
collection DOAJ
description Health care systems rely on geographical boundaries that secure financial stability and adequate planning. Quality differences across regions often arise for efficiency reasons, causing patient flows if mobility is free. In this paper, a theoretical spatial competition model is developed to study the role of patients’ mobility on quality setting and to draw policy implications on its use as an instrument to reduce disparities, in a setting where regions differ in efficiency, costs, and market structure. From the analysis, it emerges that the institutional setting matters and a trade-off may appear between equity (in terms of quality difference across patients) and welfare (finding an allocation that maximizes social benefits). In a centralized setting, it is optimal to regulate mobility and increase the quality gap, while allowing free mobility calls for a refined quality setting, in which, depending on a balance between costs and benefits, the quality gap may be either increased or decreased. In decentralization the gap is generally lower, compared to centralization: the different consideration of benefits from local quality provision results in higher quality levels where the market structure is vertically integrated.
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spelling doaj-art-7faf24e54e3c439594f65dbd5b68f8612025-08-20T02:21:02ZengMDPI AGGames2073-43362025-06-011633110.3390/g16030031Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional SettingsLaura Levaggi0Rosella Levaggi1Faculty of Engineering, Free University of Bolzano-Bozen, Via Buozzi 1, 39100 Bolzano-Bozen, ItalyDepartment of Economics and Management, University of Brescia, Via S. Faustino, 74b, 25122 Brescia, ItalyHealth care systems rely on geographical boundaries that secure financial stability and adequate planning. Quality differences across regions often arise for efficiency reasons, causing patient flows if mobility is free. In this paper, a theoretical spatial competition model is developed to study the role of patients’ mobility on quality setting and to draw policy implications on its use as an instrument to reduce disparities, in a setting where regions differ in efficiency, costs, and market structure. From the analysis, it emerges that the institutional setting matters and a trade-off may appear between equity (in terms of quality difference across patients) and welfare (finding an allocation that maximizes social benefits). In a centralized setting, it is optimal to regulate mobility and increase the quality gap, while allowing free mobility calls for a refined quality setting, in which, depending on a balance between costs and benefits, the quality gap may be either increased or decreased. In decentralization the gap is generally lower, compared to centralization: the different consideration of benefits from local quality provision results in higher quality levels where the market structure is vertically integrated.https://www.mdpi.com/2073-4336/16/3/31cross-border patients’ mobilityspatial competitioncentralized vs. decentralized provision
spellingShingle Laura Levaggi
Rosella Levaggi
Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
Games
cross-border patients’ mobility
spatial competition
centralized vs. decentralized provision
title Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
title_full Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
title_fullStr Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
title_full_unstemmed Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
title_short Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
title_sort spatial competition across borders the role of patients mobility and institutional settings
topic cross-border patients’ mobility
spatial competition
centralized vs. decentralized provision
url https://www.mdpi.com/2073-4336/16/3/31
work_keys_str_mv AT lauralevaggi spatialcompetitionacrossborderstheroleofpatientsmobilityandinstitutionalsettings
AT rosellalevaggi spatialcompetitionacrossborderstheroleofpatientsmobilityandinstitutionalsettings