Research projects

Cross-border medical care, defined as the type of care provided by a local healthcare provider under pre-arranged regional agreements, has been on the rise. When the medical attention received by the foreign patient is carried out in publicly owned centers, it is reimbursable or paid directly by the government of the country of origin. However, due to differences in the degree of health coverage in different countries, these costs are often only partially reimbursed. The resulting financial burden for some countries can be large and not reciprocal, putting strains on regional and national finances. Thus, in this project we analyze the effectiveness of a legislative measure adopted by a Spanish region in order to curb cross-border medical care. In January 2012, the Autonomous Community of Valencia approved a decree that forced the advance payment of the necessary treatment when a foreign patient needed attention in the public health services of this Autonomous Community. Subsequently, the patient had to proceed with the request for reimbursement directly with the authorities of their country of origin.
To assess the impact of this new legislative measure, we use a large administrative data set of all medical procedures performed in Spain between 2008 and 2015, and we focus on the effects on hospitalizations and total costs for the healthcare system. We estimate a difference-in-differences model where we compare the evolution of these two variables in the Autonomous Community affected by the reform with respect to the others not affected, before and after the implementation of the new legislation. Our results show a drastic decrease in the number of hospitalizations of foreigners and a reduction of 4.8 million euros/quarter in hospital costs for non-residents in Spain.