In Italy, the National Health Service (NHS, Servizio Sanitario Nazionale – SSN) guarantees universal care. In particular, the Italian NHS is a “three layers” public universal healthcare system, free of charge at the point of care [1, 2]. At national level, the Ministry of Health defines the healthcare principles and priorities, through the identification of the core benefit package of services (Livelli Essenziali di Assistenza – LEA) guaranteed across the whole country, based on collective prevention and public health, primary care and hospital care [3, 4]. Moreover, the Ministry of Health allocates funds to the regions in order to provide healthcare services and it monitors the activities of the regions. Italian regions (19 regions and 2 Autonomous Provinces), indeed, are responsible for ensuring the organization and the delivery of services through their Regional Healthcare Systems, according to the LEA defined at national level [4]. At local level, the provision of services is ensured by a regional network of Local Health Units (Azienda Sanitaria Locale – ASL) and autonomous public and private hospitals. In this context, each citizen refers to the Regional Healthcare System in which he resides. However, citizens can decide whether to be assisted by thier Regional Healthcare System or in other regions, defining the concept of active and passive interregional mobility [5]. This concept represents, at the national level, a phenomenon of healthcare mobility already known at the international level [6,7,8]. In Italy, since there are 21 different healthcare systems, it is possible to observe, therefore, the same phenomenon, albeit in a national context. In particular, active mobility indicates the attraction index of a region and identifies the healthcare services offered to non-resident citizens, while passive mobility identifies the healthcare services provided to citizens outside the region of residence (also known as escape index) [9]. Therefore, the attraction index measures the capacity of a region to attract patients from other regions. It is calculated as the proportion between the number of hospital discharges of non-resident patients in a region and the total number of hospitalizations carried out in that region. The escape index, on the contrary, quantifies the propensity of the patients to move away from their own region in order to take advantage of a healthcare service. It is calculated as the proportion between the number of hospital discharges of patients residing in a region and the total number of hospitalizations of residents in that region across the national territory. In both cases, foreign citizens and those of unknown nationality are excluded [9].
Factors such as effectiveness and efficiency of each Regional Healthcare Service, presence of Reference Centers for specific diseases, waiting lists, diagnostic services and availability of treatments, and perceived or real quality of assistance, might influence patients’ mobility [10].
Therefore, both the active and passive mobility are indicators that could be interpreted as a proxy measure of the quality (real or perceived) of the healthcare assistance provided in a region. In particular, a high index of escape may be due to deficiencies in the supply of care, while a high index of attraction may be due to a higher quality of healthcare assistance in a specific region [5, 9].
From an economic point of view, active mobility represents a credit item for the regions, while passive mobility represents a debt item; each year the region that provides the service is reimbursed by that of the citizen’s residence [11, 12].
The economic value of interregional healthcare mobility for the entire Italian population in 2018 (hospitalizations, outpatient specialists, basic medicine, territorial pharmaceuticals and direct administration of drugs and healthcare transport) was equal to a limited percentage (4.1%) of total healthcare expenditure (approximately € 113 billion). However, it has particular importance due to the impact on the financial balance (positive or negative) of regions (regions with a balance > € 100 million: Lombardy + € 750 million, Emilia-Romagna + € 327 million, Tuscany + € 144 million, Veneto + € 139 million; regions with balance < − € 200 million: Puglia - € 211 million, Sicily - € 223 million, Calabria - € 288 million, Campania - € 351 million) [5]. The analysis of healthcare mobility, therefore, represents one of the main performance indicators of Regional Healthcare Systems, both for its economic relevance and for the adequacy / satisfaction of the services provided [12].
While the data of healthcare mobility of the entire population are known [9], there is lack of evidence about both active and passive healthcare mobility of children ≤14 years old. In particular, since children living in the South regions are the most disadvantaged from an economic, educational and social point of view [13], we focused on the healthcare mobility from the South regions to the Center-North regions. In this context, the aim of the study is to analyze the healthcare mobility in 2019 in Italy for all children ≤ 14 years of age and its associated cost.